Get Ca Std. 692 2021-2025

The CA STD. 692 is a vital document used for dental plan enrollment in California. This guide offers clear, step-by-step instructions to assist users in completing the form accurately and efficiently online.

Follow the steps to complete the CA STD. 692 online successfully.

1. Click the ‘Get Form’ button to access the CA STD. 692 and bring it up in the online editor.
2. In Section A, enter your name clearly. Ensure you fill in both your first and last names.
3. In Section B, specify the type of action you are taking: whether you are enrolling in a new plan, cancelling a plan, or changing your plan or dependent coverage. Complete the appropriate sections based on your selection.
4. If you are enrolling or changing coverage, list all family members currently enrolled, as well as any to be added or deleted in the designated area. Indicate the action code next to each name.
5. Complete the personal information fields, including address, social security number, marital status, and gender, making sure to adhere to the people-first language.
6. In Section C, provide the name of your prior dental plan only if you are making a cancellation or change.
7. In Section D, choose whether you wish to enroll in a dental plan or not. Sign and date the form in the designated areas, ensuring that your signature is clear.
8. After filling out all necessary sections, review the form for accuracy. Once confirmed, you can save changes, download the completed form, print it for your records, or share it as necessary.

Complete your CA STD. 692 online to ensure your dental coverage is processed without delay.