CA PERS-HBD-85 2018 free printable template

1Health Account Management Division P.O. BOX 942715, Sacramento, CA 942292715 888 Callers (or 8882257377) TTY (877) 2497442 FAX (800) 9596545 www.calpers.ca.govGROUP CONTINUATION COVERAGE CONSOLIDATED

How to fill out CA PERS-HBD-85

How to fill out CA PERS-HBD-85

1. Obtain the CA PERS-HBD-85 form from the California Public Employees' Retirement System (CalPERS) website or your employer's HR department.
2. Read the instructions provided on the form carefully to understand the required information.
3. Fill in your personal details including your name, address, and social security number.
4. Provide your employment information such as your agency name, position, and employee ID if applicable.
5. Indicate the type of health benefits you are applying for by checking the appropriate boxes.
6. Complete any additional sections as required, such as dependent information if you are enrolling family members.
7. Review all the information you have entered to ensure it is accurate and complete.
8. Sign and date the form at the designated area.
9. Submit the completed form either in-person or through your agency’s HR department as instructed.

Who needs CA PERS-HBD-85?

1. Current employees of California state agencies who are enrolling in health benefits.
2. New employees who are setting up their health benefits for the first time.
3. Eligible family members of employees who are applying for health coverage.
4. Retirees who are updating or enrolling in health benefits through CalPERS.

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What is CA PERS-HBD-85?

CA PERS-HBD-85 is a form used by the California Public Employees' Retirement System (CalPERS) to report health benefit information for eligible employees and their dependents.

Who is required to file CA PERS-HBD-85?

Employers who participate in the CalPERS health benefits program are required to file CA PERS-HBD-85 for their eligible employees and dependents.

How to fill out CA PERS-HBD-85?

To fill out CA PERS-HBD-85, employers must provide the required information about the employee, their dependents, and relevant health coverage details as outlined in the instructions accompanying the form.

What is the purpose of CA PERS-HBD-85?

The purpose of CA PERS-HBD-85 is to ensure that health benefit information is accurately reported to CalPERS to facilitate the administration of health benefits for eligible public employees.

What information must be reported on CA PERS-HBD-85?

The information that must be reported on CA PERS-HBD-85 includes employee identification details, dependent information, health coverage selections, and any applicable dates related to enrollment or changes in status.