WebCalPERS cannot advise on the timekeeping and documentation requirements of . variable-hour employees under the Affordable Care Act. my.calpers.ca.gov . my.calpers.ca.gov . 4 Health Program Guide Enrolling Yourself and Eligible Family Members ... (HBD-12) coverage form during your initial eligibility period, whether you elect to enroll or WebEmployees must complete and submit a Health Benefit Plan Enrollment Form (CalPERS Form HBD-12), Vision Plan Enrollment Authorization (STD. 700) or Premier Vision Plan Enrollment (CalHR Form 774), CalPERS Affidavit of Parent-Child Relationship (CalPERS Form HBD-40), the Dependent Eligibility Verification Checklist (CalHR Form 781), and …

Declaration of Health Coverage HBD-12A - CPP

WebOct 15, 2024 · (CalPERS HBD-12) and provide proof of enrollment in another group medical plan. These requirements are in place whether it is your first time receiving cash in lieu or if you wish to continue receiving cash in lieu. Proof of Other Coverage You will need to provide proof of current enrollment on another group health plan, which management of salmonella infection

CalPERS State Health Benefits Guide

WebHBD-30 (6/17) Page 1 of 2 Open Enrollment You can make changes by calling 888 CalPERS (or 888-225-7377), by faxing this form to us at (800) 959-6545, or by visiting my CalPERS at my.calpers.ca.gov.. (Check this box … Webcopayment information for all CalPERS health plans • Medicare Enrollment Guide: Provides information on how Medicare works with your CalPERS health benefits If there are any inconsistencies between the Health Program Guide and the provisions of the Public Employees’ Medical Hospital Care Act (PEMHCA), the provisions of WebCalPERS HBD-12: Health Benefit Plan Enrollment Form; CalPERS HBD-34: Medical Report for the CalPERS Disabled Dependent Benefit; CalPERS HBD-40: Affidavit of Parent … criphna 8