CA CalPERS HBD-12 2002 free printable template

ITEMS 22 27. Callers RS USE ONLY DOCUMENT REFERENCE NUMBER ... PLEASE REFER TO THE HEALTH BENEFITS PROCEDURE MANUAL FOR COMPLETION ... HBD-12. Introduction Members with active employment status must

How to fill out CA CalPERS HBD-12

How to fill out CA CalPERS HBD-12

1. Obtain the CA CalPERS HBD-12 form from the official CalPERS website or your employer's HR department.
2. Begin by filling out the employee's personal information at the top of the form, including their name, address, and Social Security number.
3. Indicate the employee's position or classification and the agency name.
4. Specify the type of change you are reporting (e.g., health benefits enrollment, dependents addition/removal).
5. If adding or changing dependents, provide detailed information for each dependent, including their name, relationship, and birthdate.
6. Ensure to sign and date the form at the bottom to verify the information provided is accurate.
7. Submit the completed form to your HR department or the specified address in the instructions.

Who needs CA CalPERS HBD-12?

1. Employees participating in the CalPERS health benefits program who need to report changes in their health benefits enrollment or dependents.
2. New employees enrolling in CalPERS health benefits for the first time.
3. Employees who have experienced a qualifying event that affects their health benefits, such as marriage, divorce, or the birth of a child.

People Also Ask about

Should I use work zip code for health eligibility?

If you are an active employee, you may choose either your residential or current work address ZIP code to establish eligibility. If you are a working retiree, you may use the ZIP code of your current employer for health plan eligibility.

How do I claim my CalPERS death benefit?

This can be done by telephone or mail, or by submitting a death notification online . If the deceased was covered by CalPERS Long-Term Care, report his or her death to the program administrator at (800) 982-1775 . This will assist in the timely payment of any premium death benefits .

How do I file a claim with CalPERS?

Step 1: Call the Intake Team before you file a claim. Before you file a claim, please contact one of our Intake Specialists. Step 2: Fill out the claim form. Once your care begins, you will need to complete a claim form. Step 3: Provide authorized representatives. Step 4: Submit documentation.

How do I contact CalPERS?

We're also available by phone Monday through Friday from 8:00 a.m. to 5:00 p.m. at 888 CalPERS (or 888-225-7377).

Do CalPERS retirees get medical benefits?

Once you retire, CalPERS becomes your health benefits officer. You can change your health plan and add/delete dependents during Open Enrollment in the fall (or within 60 days of a qualifying status change). Your health premiums are deducted from your retirement pay.

How do I file for retirement CalPERS?

How to Apply for Retirement Online Log in to your myCalPERS account. Under the Retirement tab, select the Apply for Retirement link. Follow the online instructions, which will lead you step-by-step through the application. Provide any additional documents as noted to complete your online application.

For pdfFiller’s FAQs

How do I modify my CA CalPERS HBD-12 in Gmail?

In your inbox, you may use pdfFiller's add-on for Gmail to generate, modify, fill out, and eSign your CA CalPERS HBD-12 and any other papers you receive, all without leaving the program. Install pdfFiller for Gmail from the Google Workspace Marketplace by visiting this link. Take away the need for time-consuming procedures and handle your papers and eSignatures with ease.

Can I create an electronic signature for the CA CalPERS HBD-12 in Chrome?

You can. With pdfFiller, you get a strong e-signature solution built right into your Chrome browser. Using our addon, you may produce a legally enforceable eSignature by typing, sketching, or photographing it. Choose your preferred method and eSign in minutes.

Can I create an electronic signature for signing my CA CalPERS HBD-12 in Gmail?

Upload, type, or draw a signature in Gmail with the help of pdfFiller’s add-on. pdfFiller enables you to eSign your CA CalPERS HBD-12 and other documents right in your inbox. Register your account in order to save signed documents and your personal signatures.

What is CA CalPERS HBD-12?

CA CalPERS HBD-12 is a form used by California Public Employees' Retirement System (CalPERS) to report health benefits for members, including enrollments and changes in coverage.

Who is required to file CA CalPERS HBD-12?

Employers and agencies that provide health benefits to CalPERS members are required to file the CA CalPERS HBD-12 form.

How to fill out CA CalPERS HBD-12?

To fill out CA CalPERS HBD-12, you need to provide accurate member information, including their identification, coverage details, and any changes in their health benefit status. Follow the instructions provided by CalPERS for the correct format and sections to complete.

What is the purpose of CA CalPERS HBD-12?

The purpose of CA CalPERS HBD-12 is to maintain accurate records of members' health benefits and ensure proper administration of benefits by reporting any changes in coverage.

What information must be reported on CA CalPERS HBD-12?

The information that must be reported on CA CalPERS HBD-12 includes member details (name, ID, date of birth), type of coverage, enrollment status, and any changes to the health benefit plans.