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Get the free PPO Retiree 65+ with Medicare A&B (EGWP Rx)

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Declination of Coverage for RetireesI, ___ understand that as a retiree of the Lakeport Unified School District, I am eligible to continue the same district coverage that active employees enjoy. If
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PPO retiree 65 is a form for retirees aged 65 to complete for health insurance purposes.
Retirees aged 65 are required to file PPO retiree 65 form.
PPO retiree 65 form can be filled out by providing accurate and complete information as per the instructions provided.
The purpose of PPO retiree 65 form is to enroll in or make changes to health insurance coverage for retirees aged 65.
Information such as personal details, insurance coverage options, and beneficiary information must be reported on PPO retiree 65 form.
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