Get Bhsf Form Lahipp

Completing the BHSF Form LaHIPP online is crucial for determining eligibility for the Louisiana Health Insurance Premium Payment Program. This guide provides clear, step-by-step instructions to help users effectively fill out each section of the form.

Follow the steps to complete the form accurately.

1. Press the ‘Get Form’ button to access the form and open it in your editor.
2. In the employer information section, provide the employer's name, address, and phone number. Indicate whether the employer offers health insurance by selecting 'Yes' or 'No.' If the employer does not offer health insurance, proceed to Section 6.
3. In the employer insurance information section, enter the name and phone number of the insurance carrier. Specify if multiple plans are offered and whether there is an open/annual enrollment period by selecting 'Yes' or 'No.' Provide the dates for this period if applicable.
4. Next, complete the insurance coverage information section. Check all applicable coverage types provided by the insurance carrier and detail the employee’s share of monthly premiums for each standard and other applicable tiers.
5. In the employee information (ACTIVE) section, answer whether the LaHIPP applicant is a current employee. If 'Yes,' fill in the employee’s first and last name, middle initial, Social Security number, date of birth, insurance policy number, insurance group number, and sex. Specify details about premium deductions and coverage changes.
6. If the LaHIPP applicant is a terminated employee, answer the relevant questions in the employee information (TERMINATED) section. Fill in the required details, including the end employment date and COBRA information if applicable.
7. In the form filer information and signature section, indicate the name of the employer representative completing the form, their mailing address, phone number, and fax number. Sign and date the form.
8. After filling out all sections, ensure you have provided accurate information. Save changes to the form, and then you can download, print, or share it as needed.

Complete the BHSF Form LaHIPP online to ensure timely processing of health insurance premium reimbursements.