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This document is used for enrolling in the State Employee Health Plan (SEHP), making changes to health insurance coverage, and providing necessary personal and dependent information.
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How to fill out state employee health plan

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How to fill out STATE EMPLOYEE HEALTH PLAN (SEHP) DIRECT BILL GROUP HEALTH INSURANCE ENROLLMENT AND CHANGE FORM

01
Obtain the STATE EMPLOYEE HEALTH PLAN (SEHP) DIRECT BILL GROUP HEALTH INSURANCE ENROLLMENT AND CHANGE FORM from your HR department or the official website.
02
Read the instructions carefully at the top of the form to understand the requirements for filling it out.
03
Provide your personal information in the designated sections, including your name, address, employee ID, and contact details.
04
Select the appropriate enrollment option (new enrollment, change, or cancellation) as per your requirement.
05
If enrolling, choose the plan you wish to enroll in from the list provided on the form.
06
Fill out the dependent information section if you are adding dependents to your health insurance plan.
07
Sign and date the form to confirm that all information is accurate and you understand the terms.
08
Submit the completed form to your HR department or the designated office for processing.

Who needs STATE EMPLOYEE HEALTH PLAN (SEHP) DIRECT BILL GROUP HEALTH INSURANCE ENROLLMENT AND CHANGE FORM?

01
State employees who wish to enroll in or make changes to their health insurance coverage under the STATE EMPLOYEE HEALTH PLAN (SEHP).
02
Employees who are adding or removing dependents from their health insurance plan.
03
Employees changing their health insurance plan or provider.
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People Also Ask about

Use Employee Express to enroll, change, and cancel your FEHB coverage during Open Season and for some qualifying life events. If you do not see your event available in Employee Express, contact your Benefits Specialist for assistance.
During the Open Enrollment Period (OEP), you're free to make any changes you need. Outside of that window, though, you can only change plans if you qualify for a Special Enrollment Period (SEP). This can happen after certain life events, like getting married, having a baby, or losing your job.
You can enroll in a different plan during Open Enrollment. Log into your Marketplace account and update your application. Then, enroll in a plan that meets your needs. Enroll by December 15 in a new plan of your choice, for coverage to start January 1.
IRS Form 1095-C provides information regarding any employer-provided health insurance coverage – or offers of coverage. It may also detail the months of coverage you and any spouse and/or eligible dependents had during each month.
due to a life event — like changing jobs, getting married, having a baby, or based on estimated household income. Check if you qualify. You usually have 60 days from the life event to enroll in a new plan, but you should report your change as soon as possible.

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The STATE EMPLOYEE HEALTH PLAN (SEHP) DIRECT BILL GROUP HEALTH INSURANCE ENROLLMENT AND CHANGE FORM is a document used by state employees to enroll in or make changes to their health insurance coverage under the SEHP.
Employees of the state who wish to enroll in or alter their health insurance coverage through the SEHP are required to file this form.
To fill out the form, individuals must provide personal information, select the desired health coverage options, indicate any changes to previous selections, and sign the form to certify the provided information.
The purpose of the form is to facilitate the enrollment or modification of health insurance plans for state employees, ensuring they have access to the appropriate benefits.
The information that must be reported includes personal identifying details, choices of health coverage, prior health insurance information, and signature for validation.
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