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This form is used to apply for the continuation of health benefit coverage under the State Health Benefit Plan during a period of leave of absence without pay. It includes sections for member identification, leave type and payment information, member certification, agency certification, and terms and conditions related to leave types, coverage continuation, premium payments, and penalties for non-compliance.
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What is shbp 66-003?
SHBP 66-003 is a specific form related to the State Health Benefit Plan for reporting health insurance information.
Who is required to file shbp 66-003?
Entities participating in the State Health Benefit Plan are required to file SHBP 66-003, including employers, employees, and contractors involved in the state health programs.
How to fill out shbp 66-003?
To fill out SHBP 66-003, gather required documentation and information, then complete each section accurately as per the provided guidelines on the form.
What is the purpose of shbp 66-003?
The purpose of SHBP 66-003 is to collect essential data regarding health benefits coverage and ensure compliance with state health policies.
What information must be reported on shbp 66-003?
The information required on SHBP 66-003 includes details about the reporting entity, covered individuals, types of health coverage, and enrollment statistics.
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