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Get the free Download SHBP Form Request for Restrictions (PDF) - seafarers

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SEAFARERS HEALTH AND BENEFITS PLAN 5201 Auth Way Camp Springs, Maryland 20746 1 (800) 252-4674 Request For Restrictions On Use and Disclosure Of Protected Health Information Participant Name: Date
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Begin by accessing the download SHBP form request on the official website or designated platform.
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Who Needs Download SHBP Form Request?

01
Individuals who are eligible for the SHBP (State Health Benefit Plan) may need to download the SHBP form request.
02
Employees or dependents who wish to enroll or make changes to their existing SHBP coverage may require the download SHBP form request.
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Individuals who have recently experienced a qualifying event, such as marriage, divorce, birth, adoption, or a change in employment status, may need to fill out the form request to update their coverage.
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The download shbp form request is a form that allows individuals to request information or documents related to the State Health Benefits Program.
Anyone who is seeking information or documents related to the State Health Benefits Program is required to file a download shbp form request.
To fill out the download shbp form request, individuals need to provide their personal information, specify the documents they are requesting, and indicate the purpose of their request.
The purpose of the download shbp form request is to allow individuals to obtain information or documents related to the State Health Benefits Program.
The download shbp form request must include the individual's name, contact information, details of the requested documents, and the reason for the request.
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Maryland SEAFARERS Auth restriction Participant disclosed Disclosure Restrictions

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