Form HBD-12 Health Benefits Plan Enrollment for Active Employees - California

Form HBD-12 Health Benefits Plan Enrollment for Active Employees - California

What Is Form HBD-12?

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.

FAQ

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.

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Form Details:

  • Released on June 1, 2020;
  • The latest edition provided by the California Public Employees' Retirement System;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

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.

Download Form HBD-12 Health Benefits Plan Enrollment for Active Employees - California

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