Designated Benefits Administrators Access Agreement (Non-Contractors)

SHBP Employers should use this form to request or remove access to the SHBP Enrollment Portal and/or SHBP State Health Repository Tool (SHRT) for their employees, i.e. Designated Benefits Administrators.

If you are not completing this agreement on behalf of a Designated Benefits Administrator for an SHBP Employing Entity, click here to complete the correct form.