Benefits Forms & Resources
Employee Health Benefits
2024 Annual Enrollment Miniguide
2023 Decline Coverage Acknowledgment Form
2024 Decline Coverage Acknowledgment Form
2022 Active Employee Benefit Guide
2023 Active Employee Benefit Guide
2024 Active Employee Benefit Guide
2023 CalPERS Health Benefit Summary
2024 CalPERS Health Benefit Summary
2023 CalPERS Health Program Guide
2024 CalPERS Health Program Guide
CalPERS Medical Plan Enrollment Form (HBD12)
Instructions for CalPERS Medical Plan Enrollment Form (HBD12)
Affidavit of Parent-Child Relationship HBD-40
Medical Report for the CalPERS Disabled Dependent Benefit (HBD-34)
TAP & Per Diem Employee Health Benefits
Affidavits / Declarations
Consolidated Omnibus Budget Reconciliation Act (COBRA)+
Life Insurance
Flexible Spending Accounts
Retiree Health Benefits