CA PERS-HBD-85 2013 free printable template
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1 CONTINUATION COVERAGE GROUP PEERS USE ONLY: DOCUMENT REFERENCE NUMBER California Public Employees Retirement System Health Account Services P.O. Box 942715 Sacramento, CA 94229-2715 888 Callers
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How to fill out CA PERS-HBD-85
01
Obtain the CA PERS-HBD-85 form from the California Public Employees' Retirement System (CalPERS) website or your employer.
02
Fill in personal information including your name, address, and Social Security number in the designated fields.
03
Indicate your employment details, such as the name of your employer and your job title.
04
Provide information regarding your dependents, including names, dates of birth, and relationship to you.
05
Sign and date the form at the bottom to certify that the information provided is accurate.
06
Submit the completed form to your employer or directly to CalPERS as instructed.
Who needs CA PERS-HBD-85?
01
The CA PERS-HBD-85 form is needed by California public employees who wish to enroll their dependents in health benefits programs offered through CalPERS.
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What is CA PERS-HBD-85?
CA PERS-HBD-85 is a form used by the California Public Employees' Retirement System (CalPERS) to report health benefits information for active employees, retirees, or survivors.
Who is required to file CA PERS-HBD-85?
Employers participating in the CalPERS health benefits program are required to file CA PERS-HBD-85 for their eligible employees, retirees, or survivors.
How to fill out CA PERS-HBD-85?
To fill out the CA PERS-HBD-85 form, you must provide required information such as the employee's name, Social Security number, employment date, and details regarding the health benefits coverage being reported.
What is the purpose of CA PERS-HBD-85?
The purpose of CA PERS-HBD-85 is to collect necessary information from employers regarding health benefits offered to employees and retirees, which is essential for administering the health benefits program.
What information must be reported on CA PERS-HBD-85?
The information that must be reported on CA PERS-HBD-85 includes the employee's personal details, health plan selection, eligibility status, and any changes in health benefits coverage.
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