Get Calpers Long-term Care Program Application - The California ...

Completing the CalPERS Long-Term Care Program Application online is essential for individuals seeking long-term care coverage. This guide provides a clear, step-by-step process tailored to assist users of all experience levels.

Follow the steps to successfully complete your application online.

1. Press the ‘Get Form’ button to access and download the CalPERS Long-Term Care Program Application.
2. Begin filling out the application form by providing your personal information in Section A. Ensure to check the appropriate box representing your relationship to the program—active employee, spouse of a retiree, or another designation.
3. Complete the medical questions in Section B, answering each question accurately with ‘Yes’ or ‘No’ as applicable. If necessary, provide additional details on a separate sheet.
4. In Section C, authorize the release of your medical information. Sign and date this section to ensure it is valid.
5. Provide information about your primary care doctor in Section D, including their name, phone number, and address.
6. Answer the replacement coverage questions in Section E truthfully, noting any existing coverage you may want to replace.
7. In Section F, consider designating a final billing designee to receive notifications about your coverage status due to unpaid premiums.
8. Select your plan options in Section G, filling out either G1 or G2 based on your choice of coverage plan while making sure to sign the corresponding section.
9. Choose your payment options in Section H. Complete both Step 1 and Step 2, providing necessary banking information and authorizations.
10. After ensuring all sections are completed with signatures where necessary, save your changes. You may then download, print, or share the application as needed to submit it.

Start your CalPERS Long-Term Care Program Application online today to secure your future care.