Get the free hr1058. SHBP Union Negotiated Retiree Health Benefit Enrollment And/Or Change Form

HR10581020State Health Benefits Program (SHIP) State Retirees in Union Negotiated PlansRETIREE HEALTH BENEFIT ENROLLMENT AND/OR CHANGE FORM NONMEDICAL ENROLLEESMembers who attained 25 years of service

How to fill out hr1058 shbp union negotiated

How to fill out hr1058 shbp union negotiated

1. To fill out HR1058 SHBP Union Negotiated, follow these steps:
2. Begin by reading the form carefully and familiarize yourself with the requirements.
3. Provide your personal information such as name, address, and contact details.
4. Enter your employee identification number if applicable.
5. Clearly indicate your union membership information, including the union name and any relevant identification numbers.
6. Complete the sections related to your selected healthcare plan, coverage options, and premium contributions.
7. If applicable, indicate any dependents or family members who will be covered under the plan.
8. Review the filled form for accuracy and completeness.
9. Sign and date the form on the designated spaces to certify that the information provided is true and accurate.
10. Submit the completed HR1058 SHBP Union Negotiated form to the appropriate authorities or follow any additional instructions provided.

Who needs hr1058 shbp union negotiated?

1. HR1058 SHBP Union Negotiated form is specifically required by individuals or employees who are part of a union and intend to enroll in the SHBP (State Health Benefits Program) through negotiated terms. This form ensures that the necessary information for union members is collected accurately for administering their healthcare benefits within the SHBP.

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What is hr1058 shbp union negotiated?

HR1058 SHBP (State Health Benefit Plan) union negotiated refers to the specific form or documentation related to health benefits that are negotiated by a union within the framework of the State Health Benefit Plan.

Who is required to file hr1058 shbp union negotiated?

Employees who are part of a union negotiating health benefits under the SHBP are required to file the HR1058 form.

How to fill out hr1058 shbp union negotiated?

To fill out the HR1058 form, you typically need to provide personal identification details, specific union information, and any other required documentation as specified by the filing instructions.

What is the purpose of hr1058 shbp union negotiated?

The purpose of HR1058 SHBP union negotiated is to ensure that health benefits negotiated between the union and employer are properly documented and submitted for compliance and record-keeping purposes.

What information must be reported on hr1058 shbp union negotiated?

The HR1058 form must report information such as employee identification, benefits being negotiated, union details, and any relevant health plan selections or changes.