If you are looking to add a dependent to an existing health insurance plan, please complete the PS404 and gather all the required proof documents for the dependent you are adding. If the dependent is a newborn, and you do not have the birth certificate or social security card, a letter from the delivering doctor, pediatrician or other proof of birth from the hospital can be submitted.
Please submit using the "Add a Dependent" button on the right. Please note, you have 30 days from the qualifying event date to submit your request. Should you submit outside of your 30 day qualifying event window, your dependent may be subject to a 5 pay period late waiting period penalty. In addition, NYS will require you to pay for your dependents coverage on an after tax basis.
**If you are adding a newborn, and do not have their birth certificate and social security card yet, do not wait until you receive them to submit your request. You may submit those documents once you receive them.