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How to fill out the CA UBEN 100 online
The CA UBEN 100 form is essential for retirees, survivors, or disabled members to manage their medical, dental, and legal plan benefits. This guide provides detailed instructions on how to complete the form online, ensuring you have all the necessary information accurately filled out for efficient processing.
Follow the steps to successfully complete the CA UBEN 100 form online.
- Click the ‘Get Form’ button to access the CA UBEN 100 form and open it in the editor.
- Fill out your personal information in Section 1. Include your name, social security number, former campus or lab location, retirement system coverage, address, and email address.
- In Section 2, select the appropriate action regarding your plan: enroll, change, or cancel. Provide any necessary details for the selected action.
- In Section 3, indicate your choices for medical, dental, and legal plans by checking the appropriate boxes to enroll, cancel, or suspend each plan.
- Section 4 requires you to list yourself and any eligible family members, their relationship codes, and other necessary details. Ensure you check the 'E' for enroll or 'C' for cancel as applicable.
- In Section 5, provide your signature and date to confirm that you understand the participation terms and conditions. Ensure to include a daytime phone number.
- After completing all sections, review your entries for accuracy and then save your changes. You can download, print, or share the form as needed.
Complete your documents online today to ensure your benefits are managed smoothly.
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