Health Benefits Retired BillingNJ Division of Pensions andamp; Benefits 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering the corporate name of the employer and the county in the designated fields. Ensure that you also input the SHBP/SEHBP identification number accurately.
  3. Specify the effective date of the resolution by filling in the month and year. This must align with your intended start date for coverage.
  4. Complete the attached Resolution Addendum, checking appropriate boxes for coverage types (medical, dental, or both) and detailing employee classes as required.
  5. Indicate whether benefits apply to current retirees and provide any necessary percentages for employer contributions. Ensure all relevant contracts and ordinances are attached before submission.

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