Get Calpers Health Benefit Enrollment Form

Filling out the Calpers Health Benefit Enrollment Form online can streamline your enrollment process and ensure your health benefits are properly set up. This guide provides clear instructions on how to complete each section of the form effectively.

Follow the steps to complete your enrollment form.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred document viewer.
2. In the first section, select the type of action you are requesting: a new enrollment, change of coverage, or cancellation of all coverage.
3. Provide your Social Security number in the designated field to facilitate processing.
4. Enter your personal details, including your name, residence address, and contact numbers to ensure accurate communication.
5. List all individuals to be enrolled, including their names, Social Security numbers, relationships, and dates of birth.
6. Select your plan code and name of the health plan from the provided options to indicate your preference.
7. Complete the section regarding the gross premium, primary care physician, and prior health plan details if applicable.
8. Certify your election by checking the appropriate box and signing where indicated, ensuring all provided information is accurate.
9. Submit the completed form by following the submission guidelines, which may include saving changes, downloading, printing, or sharing the form.

Take the next step in securing your health benefits by completing the Calpers Health Benefit Enrollment Form online today.