Get the free HBD-12 - calpers ca

The HBD-12 is required for enrolling a member in health benefits, providing necessary proof for audits or appeals, and must be kept in the member's file.

How to fill out hbd-12 - calpers ca

How to fill out HBD-12

1. Gather necessary personal information such as name, date of birth, and contact details.
2. Obtain the required identification documents and any supporting paperwork needed for submission.
3. Refer to the specific instructions provided with the HBD-12 form to ensure compliance with requirements.
4. Complete each section of the form accurately, paying careful attention to details.
5. Review the filled form for any mistakes or missing information.
6. Sign and date the form as required.
7. Submit the completed form to the designated agency or office.

Who needs HBD-12?

1. Individuals applying for a specific benefit or service that requires the HBD-12 form.
2. Those who need to provide personal or financial documentation as part of an application process.
3. Applicants seeking government assistance or enrollment in programs requiring the form.
4. Legal representatives or guardians completing the form on behalf of someone else.

People Also Ask about

What is a health and dental enrollment form's purpose?

This enrollment form allows individuals to apply for group health and dental coverage. It's designed for employees to provide necessary personal information, dependent details, and coverage choices.

How much is CalPERS lump sum death benefit?

Group Term Life Insurance offers a lump sum payment of $5,000. In some instances, there may be an additional one-time payment based on the member's earnings (schools and public agency employees are not eligible).

What is the average CalPERS monthly pension?

The average annual CalPERS pension for all retirees who retired with a service retirement is $42,516, which breaks down to more than $3,500 per month. Overall, 61.6% of all CalPERS service retirees receive $3,500 a month or less, while only 6.4% receive more than $9,000 per month.

Who qualifies for CalPERS health benefits?

To be eligible for the CalPERS Health Program, you must: Be appointed to a job that will last at least six months and one day, work at least half time, and work for an employer contracted with CalPERS to administer their health benefits program.

What is the 6 month rule for CalPERS?

To be eligible for the CalPERS Health Program, you must: Be appointed to a job that will last at least six months and one day. Work at least half time. Work for an employer who has contracted with CalPERS to administer their health benefits program.

What is CalPERS HBD 12?

To enroll or decline enrollment in the CalPERS Health Program or to make changes to your health plan, you must submit an HBD-12 form to your Health Benefits Officer (HBO). If you have more than five dependents, please complete another HBD-12 form.

For pdfFiller’s FAQs

What is HBD-12?

HBD-12 is a specific form used to report certain financial or operational information, often related to business activities or compliance requirements.

Who is required to file HBD-12?

Businesses or organizations that meet specific criteria set by regulatory authorities are required to file HBD-12.

How to fill out HBD-12?

To fill out HBD-12, individuals must follow the provided instructions, complete all required sections accurately, and ensure all information is up to date.

What is the purpose of HBD-12?

The purpose of HBD-12 is to collect essential data for regulatory compliance, monitoring, or reporting purposes.

What information must be reported on HBD-12?

Information that must be reported on HBD-12 typically includes financial figures, operational metrics, and compliance-related details as specified by the form's guidelines.