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Los Angeles Unified School District Benefits Administration HI-22 2016 Rev. 08/16 HI-22 APPLICATION FOR CONTINUATION OF HEALTH BENEFITS
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What is hi-22 enrollment form?
The hi-22 enrollment form is a document used to enroll in a specific healthcare insurance plan.
Who is required to file hi-22 enrollment form?
Individuals who are eligible for the specific healthcare insurance plan are required to file the hi-22 enrollment form.
How to fill out hi-22 enrollment form?
The hi-22 enrollment form can be filled out online or by contacting the healthcare insurance provider directly.
What is the purpose of hi-22 enrollment form?
The purpose of the hi-22 enrollment form is to enroll individuals in a specific healthcare insurance plan.
What information must be reported on hi-22 enrollment form?
Personal information such as name, address, contact details, and eligibility criteria must be reported on the hi-22 enrollment form.
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