Get City Of Berkeley Cash-in-lieu Of Benefits Option New Employees - Cityofberkeley

This guide provides clear and detailed instructions for newly hired employees on how to complete the City Of Berkeley CASH-IN-LIEU Of Benefits Option form. Following these steps will ensure that you effectively apply for cash benefits in lieu of health insurance coverage.

Follow the steps to fill out the cash-in-lieu benefits form online.

1. Press the ‘Get Form’ button to access the form and open it for completion.
2. Begin by entering your full name in the designated field. This should be your legal name as it appears on official documents.
3. Fill out your department name, ensuring you select the appropriate department you are employed in.
4. Enter the last four digits of your Social Security number. This is a crucial identifier for your records.
5. Specify your Union Local, which is relevant for determining your benefits based on union agreements.
6. Provide your email address for any correspondence related to your application.
7. Input your employee number assigned to you by the City of Berkeley.
8. Fill in your work phone number for direct communication purposes.
9. Include your home phone number in case additional verification is needed.
10. Select whether you are a full-time or part-time employee. If part-time, specify your percentage of full-time work.
11. Indicate your hire date to establish the timeline for your employment benefits.
12. If you choose to waive the insurance coverage, confirm this by signing the statement regarding cash benefits.
13. For any existing medical or dental insurance, provide the subscriber's name, relationship to you, and their employer's details.
14. Ensure proof of your other insurance coverage is attached, which could be a card or an official statement showing your coverage.
15. Sign the authorization section, allowing the release of information to verify your other health plan.
16. Review the disclosure statement about opting for cash-in-lieu and understand the implications regarding eligibility and re-enrollment.
17. Lastly, confirm that the information is true and correct, and sign and date the document to acknowledge your agreement.
18. Once all fields are filled out, you can save changes, download, print, or share the completed form as needed.

Start your documentation process today and ensure your benefits are set up correctly by filling out the form online.