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HA08890120State Health Benefits Program (SHIP)LOCAL GOVERNMENT ACTIVE EMPLOYEE GROUPHEALTH BENEFITS ENROLLMENT and/or CHANGE FORM 1. EMPLOYEE INFORMATION Last NameFirstMIDIVISION USE ONLY Effective
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How to fill out shbp state active employee
How to fill out shbp state active employee
01
Step 1: Obtain the necessary forms for SHBP State Active Employee enrollment.
02
Step 2: Fill out the personal information section, including your name, address, and contact details.
03
Step 3: Provide your employment information, such as the name of your employer, your job title, and your hire date.
04
Step 4: Choose a healthcare plan option from the available options provided.
05
Step 5: If applicable, provide information about any dependents you wish to enroll in the SHBP State Active Employee healthcare plan.
06
Step 6: Review the completed form for accuracy and make any necessary corrections.
07
Step 7: Sign and date the form to certify its accuracy.
08
Step 8: Submit the filled-out form to the appropriate SHBP State Active Employee enrollment office.
Who needs shbp state active employee?
01
SHBP State Active Employee is needed by state employees who are eligible for the State Health Benefit Plan.
02
It is also required for any eligible dependents of these state employees who wish to enroll in the healthcare plan.
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What is shbp state active employee?
SHBP state active employee refers to a state employee who is currently enrolled in the State Health Benefit Plan.
Who is required to file shbp state active employee?
Employers are required to file SHBP state active employee information for their eligible employees.
How to fill out shbp state active employee?
Employers can fill out SHBP state active employee information through the online portal provided by the State Health Benefit Plan.
What is the purpose of shbp state active employee?
The purpose of SHBP state active employee is to ensure accurate reporting and enrollment of state employees in the State Health Benefit Plan.
What information must be reported on shbp state active employee?
Employers must report information such as employee name, ID number, coverage level, and dependents enrolled.
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