This is a legal form that was released by the California Public Employees' Retirement System - a government authority operating within California. Check the official instructions before completing and submitting the form.
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: Active employees in California who want to enroll in a health benefits plan.
Q: What information is required on Form HBD-12?
A: Form HBD-12 requires personal information, employment details, and health plan selection.
Q: Can I make changes to my health plan after submitting Form HBD-12?
A: Yes, you may be able to make changes during the open enrollment period or if you experience a qualifying life event.
Q: When is the deadline to submit Form HBD-12?
A: The deadline to submit Form HBD-12 is typically communicated by your employer.
Q: What happens after I submit Form HBD-12?
A: Your employer or the health benefits plan administrator will process your enrollment and notify you of your coverage.
Q: Are there any fees associated with Form HBD-12?
A: There are typically no fees associated with submitting Form HBD-12, but you may be responsible for paying premiums for your chosen health plan.
Q: Can I cancel my health benefits plan after enrolling with Form HBD-12?
A: You may be able to cancel your health benefits plan during the open enrollment period or if you experience a qualifying life event.
Form Details:
Download a fillable version of Form HBD-12 by clicking the link below or browse more documents and templates provided by the California Public Employees' Retirement System.