Get Lausd Hi 22 2020-2026

The Lausd Hi 22 form is an essential document for individuals seeking to continue their health benefits after retirement. This guide provides clear steps to help you navigate the process of completing this form online.

Follow the steps to successfully complete the Lausd Hi 22 form.

1. Press the ‘Get Form’ button to access the Lausd Hi 22 form and load it in the designated editor.
2. Begin by entering your employee number, last name, first name, and middle initial as instructed. Make sure to provide your address including city, state, and zip code.
3. Fill in your date of birth, phone number, and specify whether you are classified or certificated. Indicate your sex by selecting 'Male' or 'Female’.
4. Specify your retirement date and select whether it is a service retirement or disability retirement. Confirm the coverage effective date and the process date by inputting the required information.
5. In the health plans section, choose the medical, dental, and vision plans you wish to enroll in after retirement. Ensure to read any specific eligibility criteria for each plan.
6. Correctly fill in the dependent information section by providing mandatory details such as Social Security numbers for all dependents. Include names, dates of birth, relationships, and sex.
7. If applicable, fill out the Medicare information for participants aged 65 or older, including your Medicare claim number and effective dates for Medicare A and B.
8. Complete the retirement system section by indicating whether you belong to STRS or PERS and remember to attach any necessary documents as stated in the instructions.
9. Sign and date the application form to confirm that all information provided is accurate. Your application will not be processed unless it is signed.
10. Finally, after thoroughly reviewing the completed form for accuracy, save your changes, download a copy for your records, and submit the form directly to the Los Angeles Unified School District - Benefits Administration.

Complete your Lausd Hi 22 form online today to ensure a smooth transition into your retirement health benefits.