State Health Benfit Plan (SHBP) Forms

State Health Benfit Plan (SHBP) Forms

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New Enrollment / Transfer Form - used for new employees transferring SHBP coverage from a previous employer.

Change and Miscellaneous Update Form - used if the employee is currently enrolled in United Health or CIGNA plan and is experiencing a Qualifying Event. Note: complete, sign, and date form within 31 days of the qualifying event.

Required documentation must be submitted with completed form. Fax forms and required documentation to 678-301-6054.
  • Changing employee name or address - click here
  • Adding newborn or adopted child(ren) to coverage - click here
  • Adding dependent(s) to coverage - click here
  • Removing dependent(s) from coverage - click here
  • Correcting dependent(s) information - click here
  • Discontinuation Form - click here
  • New Enrollment/Transfer Form - click here
    (Used for New Hire Enrollment or Transferring SHBP coverage from a previous employer)
  • United Health Pharmacy Claim Form - click here

Wellness Promise Requirements

Biometric Screening - Physician Screening Form

For more information on state health plans or forms visit the website.