The following general information has been compiled for employees, retirees and employers as well as other interested SHBP stakeholders. Complete information is set forth in Plan Documents. In the event of a conflict between these publications and forms and the terms in the Plan Documents, the Plan Documents control.
- SHBP Acronym Glossary – Need help with health insurance alphabet soup? Visit this page to learn more about many of those acronyms.
- SHBP Decision Guides for 2016 – For active employees, retirees and new enrollees.
2016 Eligibility Changes
SHBP has gone paperless! To make a change in enrollment due to a Qualifying Event (QE), members no longer use paper forms.
Instead, members log onto the SHBP Enrollment Portal at www.mySHBPga.adp.com and declare a Qualifying Event (QE) to make the change.
- To update your address or to correct personal data, active employees must contact their Benefit Coordinator/HR department and request they submit the update on their next file to SHBP. Retirees can make their changes on the SHBP Enrollment Portal.
- Active employees or retirees who do not have web access may call the SHBP Call Center at 800-610-1863 and a representative will assist you with making the change.
- You will continue to submit QE supporting and dependent verification documentation to the secure fax at 866-828-4796. To expedite the process, the member’s social security number must be noted on each page of the documentation.
To file an appeal if your medical claim is denied in whole or in part, you must follow the procedure outlined in the Summary Plan Description (SPD) for your Plan Option. All appeals must be submitted directly to the vendor that administers your Plan Option.
To file an appeal related to eligibility for SHBP coverage and enrollment matters, you must follow the procedure outlined in the SPD. The following is a brief description of this process:
Eligibility appeals should be filed through Member Services in SHBP. The eligibility appeals process can be found in the Summary Plan Description for your Plan Option. Depending on outcomes, this may be a two-step process:
- Telephone Review - Updated 06/16/15
The Telephone Review must be performed within 31 days of the denied action concerning your eligibility through ADP. Please see linked form and follow processing directions shown..
- Formal Appeal Form - Updated 06/16/15
The Formal Appeal is the final step in the eligibility appeals process. If you received a denial from your Telephone Review, you may file a Formal Appeal, which must be postmarked within 30 days following the date of the Telephone Review decision. Please click on the “Appeals” link above for the form and follow instructions accordingly.