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SF HSS OPEN ENROLLMENT APPLICATION: RETIREE WITH MEDICARE FOR JANUARYDECEMBER 2021-YEAR PLAN You must complete this form and return it to SF HSS with required eligibility documentation by 5:00pm,

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How to fill out sfhss open enrollment application

01

Obtain the SFHSS open enrollment application form from the SFHSS website or office.

02

Fill out your personal information such as name, address, contact information, and employee ID number.

03

Provide information about your dependents if applicable.

04

Select the health insurance plan that you wish to enroll in during the open enrollment period.

05

Review the completed application form for accuracy and completeness before submitting it to SFHSS.

Who needs sfhss open enrollment application?

01

Employees of the City and County of San Francisco who are eligible for benefits through SFHSS need to fill out the open enrollment application.

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What is sfhss open enrollment application?

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

Who is required to file sfhss open enrollment application?

All eligible individuals who wish to enroll in or make changes to their health benefits coverage offered by SFHSS are required to file the open enrollment application.

How to fill out sfhss open enrollment application?

To fill out the SFHSS open enrollment application, eligible individuals must provide their personal information, any dependent information, select their desired health benefits coverage, and submit the form before the deadline.

What is the purpose of sfhss open enrollment application?

The purpose of the SFHSS open enrollment application is to allow eligible individuals to enroll in or make changes to their health benefits coverage, ensuring they have access to the appropriate health services.

What information must be reported on sfhss open enrollment application?

The SFHSS open enrollment application requires individuals to report their personal information, any dependent information, select their desired health benefits coverage, and provide any supporting documentation that may be required.

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