Clear Form Print Form State of California - Department of Human Resources PREMIER VISION PLAN ENROLLMENT AUTHORIZATION CalHR 774 (Rev 02/2013) Page 1 PVP Please type or use ballpoint pen, print clearly.

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How to fill out the Calhr Form 774 online

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!

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What is the difference between VSP basic and VSP Premier?

For an additional premium, VSP Premier offers enhanced eyeglass and contact benefits. Under either plan, you can choose a VSP network doctor or a non-VSP provider. If you use a VSP network provider you will have lower out-of-pocket costs for covered services.

Purchase the eyeglasses or contact lenses. Some popular places that accept VSP Insurance are , Walmart, Sam's Club, and Pearle Vision.

You pay a share of premium if you enroll in the VSP Basic Plan. Your premium share is the same percentage rate as your medical coverage percentage which includes Opt Out. VSP Plus plan, has better coverage for frames, coatings and progressive lenses.

Compare the Best Vision Insurance Companies CompanyPolicy Types (#)Providers in Network (#)VSP Vision Care Best Overall440,000+EyeMed Best for Plan Options3100,000+Davis Vision Most Comprehensive Coverage3131,000+UnitedHealthcare Best for Lasik Surgery2120,000+1 more row

The Premier Program connects you with a VSP doctor where you'll receive the personalized attention you deserve while maximizing your benefits. Wide selection of featured frame brands available. Featured frame brands are backed by a one-year worry-free warranty if your glasses are damaged or broken.

Frame. Frames covered in full* up to the retail allowance of $130. ® Optical allowance of $70 is equivalent to the frame allowance at VSP network doctor locations and participating retail chains.

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