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This version of the form is not currently in use and is provided for reference only. Download this version of
Form HBD-12
for the current year.
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 is eligible to use Form HBD-12?
A: Active employees in California are eligible to use Form HBD-12.
Q: What is the purpose of Form HBD-12?
A: The purpose of Form HBD-12 is to enroll in a Health Benefits Plan for active employees in California.
Q: Is there a deadline for submitting Form HBD-12?
A: The deadline for submitting Form HBD-12 may vary depending on your employer. It is best to check with your employer or Human Resources department for specific deadlines.
Q: What information is required on Form HBD-12?
A: Form HBD-12 requires personal information such as name, address, Social Security Number, as well as information about your current health benefits plan.
Q: Can I make changes to my health benefits plan using Form HBD-12?
A: Yes, you can make changes to your health benefits plan using Form HBD-12 during the open enrollment period or if you have a qualifying life event.
Q: Are there any restrictions on changing health benefits plans?
A: There may be restrictions on changing health benefits plans, such as limits on the number of times you can change plans within a year. It is best to review the specific guidelines for your employer's health benefits plan.
Q: What should I do if I have questions about Form HBD-12?
A: If you have questions about Form HBD-12, you should contact your employer or the Human Resources department of your organization.
Form Details:
- Released on January 1, 2018;
- 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;
- Fill out the form in our online filing application.
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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