Get Leave Without Pay Form - South Carolina Public Employee Benefit ... - Eip Sc

This guide provides detailed instructions on how to accurately complete the Leave Without Pay Form, a crucial document for managing insurance benefits under the South Carolina Public Employee Benefit Authority. Following this step-by-step process will help ensure that all required information is submitted correctly and efficiently.

Follow the steps to complete the Leave Without Pay Form effectively.

1. Press the ‘Get Form’ button to access the Leave Without Pay Form and open it in the editor.
2. In Section 1, enter your name, employee BIN or SSN, group name, and group number. Ensure that all details are correct, as they are crucial for identification.
3. In Section 2, indicate whether the employee is beginning Leave Without Pay (LWOP) by selecting 'Yes' or 'No'. Fill in the actual date and effective date of LWOP coverage. Include the last day actively at work and mark the relevant coverage types such as life and health.
4. If applicable, answer whether the employee is on military leave, and provide supporting documents. Ensure to fill in any necessary fields related to coverage termination if the employee chooses to end any benefits.
5. Proceed to Section 3 and indicate the return-to-work date if applicable. Complete any necessary information regarding the termination of coverage due to non-payment or wish to reinstate.
6. In Section 4, make necessary amendments if applicable and attach any relevant documentation supporting the change.
7. Finally, in Section 5, obtain both the employee's and the Benefits Administrator's signatures and dates to certify the form before submission. Ensure that all information has been accurately completed.

Take the first step towards managing your benefits by filling out the Leave Without Pay Form online today.