Get the free CalPERS Personal Physician Selection Form

Return form to Placer County Human Resources Department 145 Fulweiler Ave Ste 200 Auburn CA 95603 Subscriber first name MI Last name Address City Zip code E-mail Social Security number Home phone number Work phone number Is the subscriber and/or his or her dependent s enrolled in a Medicare plan Yes No To ensure reasonable access to services choose a Personal Physician who is located sufficiently close to each family member s home or work address. You may choose the same or a different...

How to fill out calpers personal physician selection

How to fill out calpers personal physician selection

1. Obtain the CalPERS Personal Physician Selection form from the CalPERS website or your employer.
2. Fill in your personal information such as your name, address, and contact information.
3. Consult the CalPERS provider directory to find a list of available physicians.
4. Select the physician of your choice and provide their name, address, and contact information on the form.
5. If you have dependents, indicate their names and select the same physician or a different one for each dependent.
6. Review the form for accuracy and completeness.
7. Sign and date the form.
8. Submit the completed form to your employer or directly to CalPERS according to their instructions.

Who needs calpers personal physician selection?

1. Employees who are eligible for CalPERS health benefits
2. Employees who want to have a personal physician for their medical care
3. Employees who want to have control over their choice of physician within the CalPERS network
4. Employees who value continuity of care and building a long-term relationship with their physician

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What is calpers personal physician selection?

CalPERS Personal Physician Selection allows members to choose a primary care physician to coordinate their care.

Who is required to file calpers personal physician selection?

All CalPERS members are required to file Personal Physician Selection.

How to fill out calpers personal physician selection?

CalPERS members can fill out Personal Physician Selection online through the CalPERS website or by completing a paper form.

What is the purpose of calpers personal physician selection?

The purpose of CalPERS Personal Physician Selection is to ensure members have a primary care physician to oversee their healthcare needs.

What information must be reported on calpers personal physician selection?

Members must report their chosen primary care physician and their contact information.