NEW HIRES ENROLLMENTS/QUALIFYING EVENTS
Enrollment Form – New Hires and Qualifying Events
STATE HEALTH
- All enrollments/changes must be made through the ADP Enrollment Portal: https://myshbpga.adp.com/shbp/
- New Hires can complete the SHBP Enrollment/Decline Form to be input by Benefits/Payroll.
DENTAL/VISION CLAIMS
- Dental Claim- Lincoln
- Vision Claim Out of Network – United Healthcare/Spectera
FLEXIBLE SPENDING ACCOUNTS
- Manual Healthcare FSA Claim Form
- Manual Dependent Daycare Flex Claim Form
- Dependent Card Request Form
AFLAC – ACCIDENT, CRITICAL ILLNESS AND HOSPITAL INDEMNITY
- Enrollment Form for New Hires
- Online Claim Submission (including Wellness Claims)
- Accident claim: Instructions and Accident Claim Form
- Critical Illness: Critical Illness Claim Form
- Hospital Indemnity: Hosptial Claim Form
- File a manual claim for Wellness with Direct Deposit
- Aflac Group Service Request/Cancellation Form
- Aflac Critical Illness: Online Claim Submission (including Wellness Claims)
BENEFITS TERMINATION
- Notice for employees on the benefits they may continue.
GROUP LIFE
- The Hartford Life Evidence of Insurability for Alabama.
- The Hartford Life Evidence of Insurability for Georgia.
- The Hartford Conversion Form – to convert Group Life to an Individual Policy at termination.
- The Hartford Life Claim
- Notice of Conversion and Portability Rights– with request for quote.
DISABILITY INSURANCE
- Hartford Personal Health Information Form– Evidence of Insurability for Alabama.
- The Hartford Life Evidence of Insurability for Georgia.
- Short Term Disability Claim and use policy number GRH-677721
- Long Term Disability Claim and use policy number GLT-677721
CANCER INSURANCE – ALLSTATE
- Cancer Application New Hires/Guarantee Issue or Annual Enrollment/Evidence of Insurability
- Cancer Claim Form
- Wellness Benefit
GENOMIC LIFE
To continue coverage when terminating, call 800-521-3535
INDIVIDUAL LIFE INSURANCE
LONG TERM CARE INSURANCE
Portability – Request to continue coverage