Get the free RETIREE OPEN ENROLLMENT Form due by 10/27/2017 DATE STAMP AREA
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County of Sacramento, Employee Benefits Office
700 H Street, Room 4667, Sacramento, CA 95814RETIREE OPEN ENROLLMENT
Adding Dependent(s)
Dropping Dependent(s)
Changing Plans1Form due by 10/27/2017Waiving
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How to fill out retiree open enrollment form
How to fill out retiree open enrollment form
01
First, read the instructions provided with the retiree open enrollment form.
02
Start by filling out your personal information, such as your name, address, and contact details.
03
Next, provide any required identification information, such as your social security number or employee ID.
04
Carefully review the available healthcare plans and select the one that best suits your needs.
05
If you have any dependents that should be covered under the plan, provide their information as well.
06
Make sure to indicate whether you want to enroll in dental or vision plans, if applicable.
07
Once you have completed all the necessary sections, double-check all the information for accuracy.
08
Sign and date the form, then submit it according to the provided instructions.
09
Keep a copy of the filled-out form for your records.
Who needs retiree open enrollment form?
01
Retirees who are eligible for healthcare benefits from their former employer.
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What is retiree open enrollment form?
The retiree open enrollment form is a document that allows retirees to make changes to their current benefits coverage.
Who is required to file retiree open enrollment form?
Retirees who wish to make changes to their benefits coverage are required to file the retiree open enrollment form.
How to fill out retiree open enrollment form?
Retirees can fill out the retiree open enrollment form by providing their personal information, selecting the desired benefits coverage, and submitting the form by the deadline.
What is the purpose of retiree open enrollment form?
The purpose of the retiree open enrollment form is to allow retirees to make changes to their benefits coverage for the upcoming year.
What information must be reported on retiree open enrollment form?
Retirees must report their personal information, desired benefits coverage changes, and any other relevant details on the retiree open enrollment form.
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