Get Ca Uben 100 2021-2025

Filling out the CA UBEN 100 form can be a straightforward process when you have clear guidance. This comprehensive guide will walk you through each section of the form, ensuring accuracy and compliance while submitting your information online.

Follow the steps to successfully complete the CA UBEN 100 form.

1. Click the ‘Get Form’ button to access the CA UBEN 100 form and open it in your preferred editor.
2. Begin by filling out your personal information in section 1. Provide your full name, Social Security number, former campus or lab location, and retirement system coverage details. Make sure to enter your current home and mailing addresses, along with your email.
3. In section 2, indicate the action you are requesting. Select whether you are enrolling or changing your coverage, and provide necessary details such as marriage or partnership dates, and reasons for enrollment changes.
4. For section 3, select your desired medical, dental, and legal plans. Be sure to note if you want to enroll, cancel, or suspend your current coverage.
5. In section 4, list all eligible family members for coverage. Include their names, relationship codes, birthdates, and Social Security numbers for each individual.
6. Review the participation terms and conditions carefully. You need to acknowledge and accept these terms as part of the form submission.
7. In the final section, provide your signature—not a typed version—along with the date. Ensure that everything is filled out clearly to prevent processing delays.
8. Once complete, save your changes, then download or print a copy of the form for your records. You can then submit the form by fax or mail according to the instructions provided.

Start completing your CA UBEN 100 form online today for a smoother benefits enrollment experience.