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MAXSIP LLC 

SimplyHome / SHIFT

Complete this form to enroll in or change your voluntary benefits for this upcoming year.

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For Open Enrollment Only 

Effective January 1, 2026

Determine STD Premium

Benefit Options

You have two health insurance plan options for 2026. Please select your plan below.
BSBC $2000 Deductible PPO
BCBS HSA $5300
I choose to opt out of this coverage.
Who would you like to enroll in your BCBS Health Insurance Plan?
Employee Only
Employee + Spouse / Domestic Partner
Employee + Child(ren)
Family

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