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This document provides an overview of the Consolidated Benefits Program for State of California employees, detailing the selections for health and dental benefits, the eligibility criteria, the CoBen
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How to fill out CoBen 2012

01
Obtain a copy of the CoBen 2012 form.
02
Gather required information such as personal details, employment information, and dependent data.
03
Fill out the form with accurate personal details including name, address, and Social Security number.
04
Provide information regarding your employment status and employer details.
05
List any dependents that you are claiming.
06
Review the form for any errors or missing information.
07
Sign and date the form where indicated.
08
Submit the completed form to the appropriate agency or organization.

Who needs CoBen 2012?

01
Employees who participate in benefit programs.
02
Individuals claiming deductions for health-related expenses.
03
Families seeking reimbursement for qualified medical expenses.
04
Employers managing benefit programs for their employees.
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CoBen 2012 is a form used in California for the election of health benefits and the reporting of salary reduction agreements for employees.
Employees who wish to enroll in or make changes to their health benefits under the CoBen program are required to file CoBen 2012.
To fill out CoBen 2012, employees need to provide personal information, select their desired benefits, and specify any salary reductions applicable to their choices.
The purpose of CoBen 2012 is to facilitate the process of choosing and reporting health benefits for employees, ensuring compliance with state regulations.
Information that must be reported on CoBen 2012 includes employee identification, benefit selections, and any applicable salary reduction amounts.
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