This document contains official instructions for Form HBD-12 , Health Benefits Plan Enrollment for Active Employees - a form released and collected by the California Public Employees' Retirement System. An up-to-date fillable Form HBD-12 is available for download through this link.
Q: What is Form HBD-12?
A: Form HBD-12 is a health benefits plan enrollment form for active employees in California.
Q: Who needs to fill out Form HBD-12?
A: Form HBD-12 needs to be filled out by active employees in California who want to enroll in a health benefits plan.
Q: What information do I need to provide on Form HBD-12?
A: You will need to provide your personal information, employment details, and choose a health benefits plan.
Q: When do I need to submit Form HBD-12?
A: You should submit Form HBD-12 within the enrollment period specified by your employer.
Q: Who should I contact if I have questions about Form HBD-12?
A: You should contact your employer or the human resources department for assistance with Form HBD-12.
Download your copy of the instructions by clicking the link below or browse hundreds of other forms in our library of forms released by the California Public Employees' Retirement System.