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Pensions and Benefits

STATE HEALTH BENEFITS PROGRAM (SHBP) and
SCHOOL EMPLOYEES' HEALTH BENEFITS PROGRAM (SEHBP)

Health Benefits Rates and Information
FOR PLAN YEAR 2017

Update: Open Enrollment for Active Employees ends November 11, 2016

Links for Active Employees: Review Your Medical and Dental Plan Choices | Calculate Your Costs
Applications - Click Here to Change Your Benefits

Additional Links for: COBRA Members

Over Age Dependents | Newsletters | Employer Information


ACTIVE EMPLOYEES — Review Your Medical and Dental Plan Choices:

Medical Plan Design Comparison Charts for Active Employees

Participating Employee Dental Plans


ACTIVE EMPLOYEES — Calculate Your Cost:

Percentage of Premium Calculators and Worksheets — Revised for the new medical plans and rates effective in Plan Year 2017.

State Active Employee Medical Plan Rates

Local Government and Education Employee Medical Plan Rates

EMPLOYEE DENTAL PLANS

State Active Employee Dental Plan Rates

Local Government and Education Employee Dental Plan Rates


ACTIVE EMPLOYEES — Applications for Medical/Prescription Drug and Dental Benefits:

State Employee (SHBP Medical/Prescription Drug Plan) Applications
Application for TIERED NETWORK/PPO/HMO Plans Adobe PDF (54K)
High Deductible Health Plans Adobe PDF (54K)
     and HSA Contribution Forms for Centralized Payroll | Other State Employees Adobe PDF (23K)

Local Government Employee (SHBP Medical/Prescription Drug Plan) Applications
Application for TIERED NETWORK/PPO/HMO Plans Adobe PDF (54K)
Application for High Deductible Health Plans Adobe PDF (54K)
    and HSA Contribution Form Adobe PDF (23K)

Local Education Employee (SEHBP Medical/Prescription Drug Plan) Applications
Application for PPO and HMO Plans Adobe PDF (52K)
Application for High Deductible Health Plans Adobe PDF (54K)
     and HSA Contribution Form Adobe PDF (23K)

Employee Dental Plans Application (for eligible Active Members)

PLEASE NOTE: Completed applications must be returned to your human resources representative or benefits administrator for certification. Do not submit your application directly to the Division of Pensions and Benefits.


COBRA MEMBERS

COBRA Rates

COBRA Active Group Rates

State Group Adobe PDF (25K)

Local Government Group Adobe PDF (37K)

Local Education Group Adobe PDF (35K)

COBRA Dental Rates

State Group Adobe PDF (18K)

Local Government/Education Group Adobe PDF (18K)

COBRA Part-Time Chapter 172 Rates

State Part-Time Adobe PDF (25K)

Local Part-Time Adobe PDF (33K)

COBRA Retiree Rates

State Group Adobe PDF (23K)

Local Government Adobe PDF (24K)

Local Education Adobe PDF (24K)

COBRA Applications

State and Local Employees
PPO and HMO Plans Adobe PDF (96K)
High Deductible Health Plans Adobe PDF (96K)

Education Employees
PPO and HMO Plans Adobe PDF (96K)
High Deductible Health Plans Adobe PDF (96K)

NOTE: COBRA Applications must be certified by the employer before sending it to the Division of Pensions and Benefits.


OVER AGE DEPENDENTS

Over Age Dependents to Age 31 under Chapter 375

State Employees and Retirees Adobe PDF (19K)

Local Government Employees and Retirees Adobe PDF (20K)

Local Education Employees and Retirees Adobe PDF (11K)

Chapter 375 Application

Application for Chapter 375 Coverage Adobe PDF (27K)


NEWSLETTERS

State Employees Health Capsule

Local Government Employees Health Capsule

Education Employees Health Capsule


EMPLOYER INFORMATION

Open Enrollment Webinar Presentations

Employer Resolutions

Resolution Forms to Limit Medical Plans Offered under the SHBP/SEHBP for Local Government Employers or Local Education Employers

Resolution Form for Pilot Incentive Program for the Tiered-Network plans for Local Government

SHBP and SEHBP Rate Renewal Reports

 

 
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