Get Ca Calhr 695 2021-2026

The CA CalHR 695 is an important document for retirees wishing to enroll in a vision plan. This guide will provide step-by-step instructions to help users complete the form accurately and efficiently online.

Follow the steps to successfully complete the CA CalHR 695 form online.

1. To access the form, click the ‘Get Form’ button to retrieve it and open it in your preferred online editor.
2. In section A, enter your retiree information. Fill in your full name, date of birth, social security number, address, and contact number. Select the type of action you are requesting: new enrollment, COBRA, change, or cancel. Also, choose your preferred vision plan (Premier or Basic) along with the corresponding code.
3. In section B, indicate your enrollment election. Select the box affirming your choice to enroll in a vision plan or choose to decline enrollment. It's important to understand the terms, as the enrollment may lead to deductions from your retirement warrant.
4. Complete section C if you have dependents. Provide their names, social security numbers, dates of birth, dependent types, and genders. Remember that you can only enroll eligible dependents.
5. Section D is for employing agency use only. While you typically will not fill this section out, ensure that all the required boxes are addressed by the appropriate agency representative.
6. Review all the information entered for accuracy. Once confirmed, proceed to save your changes, and prepare the form for submission. You will have options to download, print, or share the completed form as necessary.

Complete your CA CalHR 695 form online today for easy enrollment in your vision plan.