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20212022 SA USD BenefitsCOBRA Enrollment Forestall USE ONLY Event Date:Effective Date:Enrollment Change Type:AddDropOther:Section 1 Subscriber Information Print or type in dark ink and check each
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The wwwsausduscmslib2021- sausd benefits self-pay is a form where employees can elect to pay for certain benefits offered by SAUSD out of their own pocket.
All SAUSD employees who wish to elect to self-pay for benefits must file the wwwsausduscmslib2021- sausd benefits self-pay form.
To fill out the wwwsausduscmslib2021- sausd benefits self-pay form, employees must provide their personal information, select the benefits they wish to self-pay for, and sign the form.
The purpose of the wwwsausduscmslib2021- sausd benefits self-pay form is to allow employees to choose and pay for additional benefits offered by SAUSD on their own.
Employees must report their personal information, benefits selection, and payment details on the wwwsausduscmslib2021- sausd benefits self-pay form.
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