CA PERS-HBD-85 2019-2025 free printable template
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Health 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
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How to fill out CA PERS-HBD-85
01
Obtain the CA PERS-HBD-85 form from the official PERS website or your employer.
02
Fill in your personal information, including your name, Social Security number, and date of birth.
03
Indicate your employment information, including your agency, position, and start date.
04
Provide details about your current health plan coverage, if applicable.
05
Select the dependent(s) you want to enroll in the health coverage, if any.
06
Sign and date the form to certify that the information provided is accurate.
07
Submit the completed form to your HR department or the appropriate PERS office.
Who needs CA PERS-HBD-85?
01
Employees of California public agencies who are eligible for health benefits.
02
Individuals enrolling in health benefits for themselves or their dependents.
03
Retirees who wish to continue health coverage after retirement.
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What is CA PERS-HBD-85?
CA PERS-HBD-85 is a form used by public employees in California to report health benefits enrollment status and to provide information about dependent coverage.
Who is required to file CA PERS-HBD-85?
Employees who are eligible for health benefits through the California Public Employees' Retirement System (PERS) are required to file CA PERS-HBD-85.
How to fill out CA PERS-HBD-85?
To fill out CA PERS-HBD-85, individuals must provide their personal information, including name, social security number, and employment details, as well as any relevant dependent information and health plan selections.
What is the purpose of CA PERS-HBD-85?
The purpose of CA PERS-HBD-85 is to collect and maintain accurate information regarding health benefit enrollment for state employees and their dependents.
What information must be reported on CA PERS-HBD-85?
The information that must be reported on CA PERS-HBD-85 includes employee details, dependent information, selected health plans, and any changes to health benefit coverage.
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