The Empire Plan is a unique health insurance plan designed especially for public employees in New York State. Empire Plan benefits include inpatient and outpatient hospital coverage, medical/surgical coverage, Centers of Excellence for transplants, infertility and cancer, home care services, equipment and supplies, mental health and substance abuse coverage and prescription drug coverage.
ANDREW M. CUOMO
Governor
LOLA W. BRABHAM
Acting Commissioner
NY20-14
PE20-12
TO: All Health Benefits Administrators (HBAs)
FROM: Employee Benefits Division
SUBJECT: Revised Sick Leave Credit Election, Deferral and Preservation Forms
DATE: June 29, 2020
The Employee Benefits Division (EBD) has renamed and revised the forms for sick leave credit election, deferral and preservation. The new names are as follows:
- NYSHIP Sick Leave Credit Option Election Form (PS-405)
- NYSHIP Health Insurance Deferral Election Form (PS-406.2)
- NYSHIP Sick Leave Credit Preservation Form (PS-410)
Effective immediately, please discontinue use of all prior versions.
The new versions are attached to this memo and are posted online under the Publications & Forms tab of HBA Online. The revisions are intended to make the forms more user friendly to both enrollees and HBAs.
For more information regarding the Sick Leave Credit option and deferring health insurance into retirement, please refer to the appropriate General Information Book or the HBA Manual for your group.
If you have any further questions after reviewing these resources, please contact the HBA Help Line at 518-474-2780; representatives are available between the hours of 9:00am to 4:00pm, Monday through Friday.
If you need help accessing HBA Online, contact the ITS Service Desk at 844-891-1786, fixit@its.ny.gov or via chat at https://chat.its.ny.gov.