Get Ca Lausd Hi-22 2022-2025

Filling out the CA LAUSD HI-22 form online is a crucial step for employees seeking to continue their health benefits after retirement. This guide offers step-by-step instructions to help you navigate each section of the form with ease and confidence.

Follow the steps to complete the CA LAUSD HI-22 online.

1. Click the ‘Get Form’ button to access the HI-22 form and open it in the editor.
2. Enter your personal information, including your employee number, last name, first name, middle initial, date of birth, address, email address, phone number, and social security number. Ensure accuracy in all entries to avoid any processing delays.
3. Indicate your retirement date and specify whether you are applying for service retirement or disability retirement.
4. Select the health plans you wish to be enrolled in at the time of retirement. You will see various options for medical, dental, and vision plans. Make sure to check the criteria, especially regarding age and Medicare enrollment, before making your selections.
5. Provide information for any dependents you wish to include. This includes their names, social security numbers, dates of birth, and relationships to you. Make sure to attach additional pages if required.
6. If applicable, fill out the Medicare information section, which includes details for you and/or your spouse 65 or older, along with mandatory Medicare card copies.
7. Confirm whether your spouse or domestic partner is an LAUSD employee or retiree and provide the employee number, if applicable.
8. Sign and date the form, certifying that all information provided is accurate and true to the best of your knowledge.
9. Review the entire form to ensure all sections are completed accurately. Once verified, you may save your changes, download, print, or share the filled-out form as required.

Complete your CA LAUSD HI-22 online today to ensure you receive your health benefits without delay.