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Get CA SFHSS Open Enrollment Application - San Francisco 2020

By 5:00pm, October 31, 2019, if any of the following apply: • You are changing medical or dental elections for January to December 2020. • You are adding or dropping dependents effective January to December 2020. • You are enrolling or re-enrolling in a Flexible Spending Account (FSA) effective from January 1 to December 31, 2020. Do not complete this form if all of the following apply: • You elect to keep the same medical and dental coverage that you had from January to December 2019. .

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