Transcription of State Health Benefits Program (SHBP) • School Employees ...
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State Health Benefits Program (SHBP) • School Employees ...
Effective Dates Event Reason: D _____ _____ _____ EMPLOYER CERTIFICATION (See Instructions on reverse) Employer Name _____ Payroll # _____ ( State Biweekly) Union Code (Rx) Only Location # ( State Monthly or Local /Education) 10/12 - month employee (Enter 10 or 12 ) MEMBER ACTION o New Enrollment o Transfer Date Employment Began _____/_____/_____ o Return from Leave of Absence _____/_____/_____Signature of Certifying Officer Telephone # Date MailedState Health Benefits Program (SHBP)
The State Health Benefits Program (SHBP) and School Employees’ Health Benefits Program (SEHBP) are required to ensure that only employees, retirees, and
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