Get Monthly Change Summary - State Of New Jersey - Nj

Filling out the Monthly Change Summary is essential for employers participating in the New Jersey State Health Benefits Program. This guide provides detailed, step-by-step instructions for completing the form online efficiently and accurately.

Follow the steps to complete the Monthly Change Summary form online.

1. Press the ‘Get Form’ button to retrieve the Monthly Change Summary form and open it in your document editor.
2. Enter the name of your employer in the designated field, ensuring accuracy for proper identification.
3. Fill in the County name where the employer is located.
4. Input the SHBP Location Number from your billing report into the provided space.
5. In the Summary of Transactions section, report the following: For 3a, indicate the total number of new enrollment forms being submitted. For 3b, enter the number of coverage change forms submitted. For 3c, calculate and record the total forms submitted by adding the numbers from 3a and 3b. For 3d, document the number of deletions noted in the Transmittal of Deletion form. For 3e, indicate the total number of rejected forms.
6. Ensure that the Certifying Officer signs and dates the form in the appropriate fields.
7. Complete the area for all employees represented in the summary of transactions. Include their name, coverage type, effective date, and type of change. If additional space is needed, use a second form and attach it securely.
8. Review the completed form for accuracy, then save changes, download the document, print it, or share it as necessary.

Complete the Monthly Change Summary online today to ensure timely processing of your transactions!