Get Calhr 025 Form

The CalHR 025 Form is the Affidavit of Parent-Child Relationship, which allows employees and annuitants of the State of California to enroll their dependents in the CalPERS Health Benefits Program. This guide provides a comprehensive step-by-step approach to filling out the form online, ensuring that you understand each section and the necessary requirements.

Follow the steps to complete the CalHR 025 Form online.

1. Press the ‘Get Form’ button to access the CalHR 025 Form and open it in the designated online editor.
2. In Section A: Employee/Annuitant Information, fill in your name, Social Security number, date of birth, the date you took on primary parental status or duties for the dependent child, and your relationship to the child.
3. In Section B: PCR Dependent Information, provide the dependent's name, Social Security number, date of birth, and their address if it differs from yours.
4. In Section C: Supporting Documentation Requirements, select 'yes' or 'no' to confirm whether your dependent is under age 19 or aged between 19 and 26, indicating your intent to submit required documentation.
5. In Section D: Signature of Employee/Annuitant, sign and date the affidavit to certify that the information you provided is true and to acknowledge your responsibility to submit required documentation.
6. In Section E: For Employer Use Only, if you are an active employee, ensure your employer completes this section. If you are a retiree, you may leave this section blank.
7. Once all sections are completed, ensure you save the changes to the document, then download, print, or share the form as necessary.

Complete your CalHR 025 Form online to ensure your dependent is enrolled in the health benefits program.