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.
KATHY HOCHUL
Governor
TIMOTHY R. HOGUES
Commissioner
NY22-26
PE22-18
PA22-16
SEHP22-12
PAEX22-14
TO: Health Benefit Administrators
FROM: Employee Benefits Division
SUBJECT: NYS Gender Recognition Act Impact on NYSHIP Forms and Procedures
DATE: November 7, 2022
The Gender Recognition Act (GRA) enables New Yorkers to select a non-binary or gender non-conforming option on their New York State issued driver’s licenses, State ID cards, and birth certificates. NYS agencies are also required to include a third gender option on all forms that collect gender or sex information. In response, a number of NYSHIP forms are being revised and the New York Benefit Eligibility and Accounting System (NYBEAS) will be updated later this year to allow HBAs to enter a non-binary (gender X) option that enrollees or dependents may select on such forms.
NYBEAS will include the non-binary (gender X) option in the selection field for enrollees and dependents. In addition, the “relationship to employee” field for dependent children will no longer have the option for “son” or “daughter”, it will simply list “child.” Both changes will become effective in NYBEAS on December 30, 2022. At that time, the following updated forms will also be posted online:
- PS-404 - NYSHIP Health Insurance Transaction Form for NYS & PE Employees
- PS-404G - NYSHIP Health Insurance Transaction Form for SEHP
- PS-404R - NYSHIP Health Insurance Transaction Form for NYS & PE Retirees
- PS-503 - NYSHIP Health Insurance Transaction Form for Participating Agencies (PAs)
- PS-425 - NYSHIP Domestic Partner Enrollment Application
- PS-457 - NYSHIP Statement of Dependence for Other Children
(No longer collects gender information) - PS-934 - M/C Life insurance Transaction Form
Pursuant to Civil Rights Law, Chapter 6, Article 6-A, Section 67(2), individuals may self-attest to all gender designation changes. The enrollee or dependent is only required to submit a signed form, such as a PS-404 or PS-503, or a signed statement requesting the gender designation change. No additional documentation is required.
Regarding name changes, an enrollee or dependent must continue to provide a signed request to change their name along with a court order or government issued identity document, such as a drivers’ license or non-driver identity card, documenting the new name before the change can be effectuated in NYBEAS.
If you have any questions after reviewing this memo, please contact the HBA Help Line at 518-474-2780; representatives are available between the hours of 9:00 am to 4:00 pm, Monday through Friday.