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SF HSS OPEN ENROLLMENT APPLICATION : RETIREE WITH MEDICARE FOR JANUARYDECEMBER 2018-YEAR PLAN You must complete this form and return it to SF HSS with required eligibility documentation by 5:00 pm,

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How to fill out sfhss open enrollment application

01

Step 1: Obtain the sfhss open enrollment application form from the HR department or the official website.

02

Step 2: Read the instructions carefully and gather all the necessary documents and information.

03

Step 3: Fill out the personal information section, including your full name, date of birth, and contact details.

04

Step 4: Provide information about your current health insurance coverage, if applicable.

05

Step 5: Choose the desired plan or options for the open enrollment period.

06

Step 6: Review your application form to ensure all the required fields are filled correctly.

07

Step 7: Sign and date the application form.

08

Step 8: Submit the completed application form to the designated HR personnel or office.

Who needs sfhss open enrollment application?

01

Any employee or eligible member of the San Francisco Health Service System (sfhss) who wants to enroll or make changes to their health insurance coverage needs the sfhss open enrollment application.

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What is sfhss open enrollment application?

SFHSS open enrollment application is a form that allows eligible individuals to enroll in or make changes to their health benefits coverage.

Who is required to file sfhss open enrollment application?

Any eligible individual who wants to enroll in or make changes to their health benefits coverage through SFHSS is required to file the open enrollment application.

How to fill out sfhss open enrollment application?

The SFHSS open enrollment application can be filled out online or submitted in person to the SFHSS office. It requires basic personal information and selections for health benefits coverage.

What is the purpose of sfhss open enrollment application?

The purpose of the SFHSS open enrollment application is to allow individuals to make changes to their health benefits coverage and ensure they have the appropriate coverage for the upcoming year.

What information must be reported on sfhss open enrollment application?

The SFHSS open enrollment application requires information such as personal details, dependent information, health plan selections, and any requested changes to coverage.

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