Get Csu Vsp Retiree Enrollment Form

Filling out the Csu Vsp Retiree Enrollment Form online is a straightforward process that allows retirees to secure vision care coverage. This guide will provide step-by-step instructions to ensure that you complete the enrollment efficiently and accurately.

Follow the steps to complete your enrollment form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Select your coverage option by checking one of the boxes: 'Retiree Only', 'Retiree + One Dependent', or 'Retiree + Family'.
3. Fill in the retiree information section, including your first name, last name, social security number (SSN), home address, city, state, zip code, email address, phone number, and date of birth.
4. If your billing address differs from your home address, complete the billing address section.
5. In the dependent section, if applicable, provide the dependent's SSN, name, date of birth, and relationship to you.
6. Review the acknowledgment statement carefully before signing. Ensure that all the information is accurate and that you understand the terms regarding coverage duration and premium deductions.
7. Sign and date the form at the designated fields to confirm your agreement to the terms.
8. After completing the form, save your changes, download the document, or print it for mailing.

Complete your Csu Vsp Retiree Enrollment Form online to ensure your vision care coverage.