Get Calhr Form 774

This guide provides a detailed, step-by-step process for completing the Calhr Form 774 online. Designed for ease of use, this comprehensive resource aims to support individuals in enrolling in the Premier Vision Plan efficiently.

Follow the steps to complete the Calhr Form 774 online effectively.

1. Press the ‘Get Form’ button to access the Calhr Form 774 and open it in your online editing tool.
2. Begin with Section A - Employee Information. Enter your last name, first name, middle initial, social security number, date of birth, mailing address, telephone number, and email address. Ensure all information is typed clearly.
3. Indicate the type of action you wish to take by selecting from the options provided: 'New Enrollment', 'Change', 'Cancel', or 'New COBRA Enrollment'.
4. Move to Section B - Dependent Information if applicable. Mark an 'A' for add or 'D' for delete next to dependents' names. If you have more dependents, attach additional pages. Only eligible dependents can be enrolled.
5. Proceed to Section C - Enrollment Election. Select the appropriate box to indicate your choice to enroll in the vision plan or to opt out. Understand that this selection authorizes deductions to be made for premiums.
6. Read and acknowledge the general terms of enrollment by signing and dating the form in the designated area.
7. Complete Section D if you are part of an employing agency. Fill in required details such as deduction code, employee premium deduction amount, and agency information. Ensure that the authorized agency signature is also included.
8. Once all sections are completed, review the form for accuracy. You can then save your changes, download, print, or share the completed form as needed.

Complete your Calhr Form 774 online for a smooth enrollment experience!