NSHAPP 2800(Employee Enrollment Form) 2-9 group-2026

1. Click ‘Get Form’ to open the NSHAPP 2800 Employee Enrollment Form in the editor.
2. Begin with Section I, where you will enter your Employer Information. Fill in the Group Number, Employer Name, and complete the address fields including City, State, and Zip Code.
3. Move to Section II for Employee Information. Provide your Last Name, First Name, Middle Initial, Gender, Residence Address, and contact numbers. Ensure you include your Social Security Number and Date of Birth.
4. In Section III, indicate your coverage elections by checking the appropriate boxes for yourself and any dependents. Remember that you must elect coverage for yourself for dependents to be eligible.
5. If applicable, complete the Waiver of All Coverages section if you are declining all offered coverages. Provide a reason for declining if necessary.
6. Fill out Section IV regarding Beneficiaries only if selecting Life or AD&D benefits. List their names, relationships, and Social Security Numbers as required.
7. Review Sections V and VI carefully before signing to confirm that all information is accurate and complete.

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