Get the free CalHR 689 - FlexElect Program COBRA Continuation Election Form - dpa ca

STATE OF CALIFORNIA DEPARTMENT OF PERSONNEL ADMINISTRATION DPA-689 Rev. 06/2005 Print Form Reset Form CONSOLIDATED OMNIBUS BUDGET RECONCILIATION ACT (COBRA) DESELECT PROGRAM CONTINUATION COBRA ELECTION

How to fill out calhr 689 - flexelect

How to fill out calhr 689 - flexelect?

1. Gather all necessary information: Before starting to fill out the form, make sure you have gathered all the required information. This includes personal details such as name, address, and social security number, as well as information regarding your employment and benefits eligibility.
2. Understand the instructions: Read through the instructions provided with the form carefully. This will help you to understand the purpose and requirements of the calhr 689 - flexelect form.
3. Provide accurate personal information: Begin by filling in your personal details accurately. This includes your full name, address, date of birth, and social security number. Ensure that the information provided is correct and matches the records of your employer.
4. Section A - Employee Information: This section requires you to provide details about your employment. Fill in your employee identification number, job classification, and department. Additionally, indicate whether you are a permanent, part-time, or temporary employee.
5. Section B - Health Plan Enrollment: In this section, you need to indicate your preferred health plan. Choose the appropriate box that corresponds to your desired health plan option. If you wish to waive coverage, select the relevant option and provide a written explanation if required.
6. Section C - Enrollment in Dependent Care Assistance Program (DCAP): If applicable, indicate your participation in the DCAP by selecting the appropriate box and providing the requested information. This section may require details about your eligible dependents and the anticipated cost of care.
7. Section D - Confirmation and Signature: Once you have completed all the necessary sections, carefully review the information provided. Make sure all the details are accurate and properly filled. Sign and date the form in the designated areas to confirm your submission.

Who needs calhr 689 - flexelect?

1. Employees of companies that offer the flexelect program: The calhr 689 - flexelect form is required to be filled out by employees who are eligible for the flexelect program offered by their employer. This includes individuals who wish to enroll in or make changes to their health plan options or participate in the Dependent Care Assistance Program (DCAP).
2. Employees seeking to customize their benefits package: The calhr 689 - flexelect form is particularly relevant for employees who want to customize their benefits package according to their specific needs and circumstances. It allows individuals to choose their health plan, including waiving coverage if appropriate, and participate in DCAP if they have eligible dependents and require assistance with dependent care expenses.
3. Employees experiencing qualifying life events: The form may also be required for employees who experience qualifying life events such as marriage, divorce, birth, or adoption of a child. These events may necessitate changes to the employee's health plan or DCAP participation, and the calhr 689 - flexelect form provides a means to make these adjustments.

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What is calhr 689 - flexelect?

CALHR 689 - flexelect is a form used by employees of the California Department of Human Resources (CALHR) to participate in the FlexElect Program, which allows them to choose among different health and dental plans.

Who is required to file calhr 689 - flexelect?

All eligible employees of CALHR are required to file CALHR 689 - flexelect if they wish to participate in the FlexElect Program.

How to fill out calhr 689 - flexelect?

To fill out CALHR 689 - flexelect, employees need to provide their personal information, select their desired health and dental plans, and make any necessary changes or updates to their current enrollment.

What is the purpose of calhr 689 - flexelect?

The purpose of CALHR 689 - flexelect is to allow employees of CALHR to choose and enroll in the health and dental plans that best meet their individual needs and preferences.

What information must be reported on calhr 689 - flexelect?

CALHR 689 - flexelect requires employees to report their personal information such as name, address, and dependents, as well as their selections for health and dental plans.

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