Std 692 2026

See details

4.3 out of 5

129 votes

The document is a Dental Plan Enrollment Authorization form from the California Department of Human Resources. It outlines the process for employees to enroll in, cancel, or change their dental plan coverage, including sections for personal information, family member details, and authorization for payroll deductions. It also includes a privacy notice regarding the handling of personal information.

Here's how it works

01. Edit your form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out std 692 with our platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open the STD 692 in the editor.
Begin with Section A, selecting the type of action: New Enrollment, Cancel, Change, or COBRA. Fill in your name and social security number clearly.
In Section B, specify the dental plan name and provider/facility number if applicable. List all family members to be enrolled or deleted, marking them with action codes A (Add) or D (Delete).
Proceed to Section C if you are changing plans; provide the prior dental plan name.
In Section D, check the appropriate box regarding your enrollment decision and sign where indicated. Ensure you date your signature.
Finally, review all sections for accuracy before submitting your completed form to your personnel/payroll office.

Start using our platform today for free to simplify your STD 692 form completion!

See more std 692 versions

We've got more versions of the std 692 form. Select the right std 692 version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2021	4.8 Satisfied (124 Votes)
2019	4.4 Satisfied (251 Votes)
2016	4.3 Satisfied (129 Votes)
2012	4.4 Satisfied (180 Votes)
2000	4 Satisfied (44 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is the most common form of dental insurance?

The two most common types of dental plans are dental preferred provider organization (DPPO) plans and dental health maintenance organization (DHMO) plans. A DPPO plan allows you to visit any licensed dentist, in or out of network although you may pay more for out-of-network services.

What is the dental insurance for low income people in California?

Medi-Cal Dental is the program that provides free or low-cost dental services to eligible children and adults. The Medi‑Cal Dental Program provides free or low‑cost dental services to children and adults who receive Medi‑Cal, Californias Medicaid program.

Is it too late to get dental insurance?

Its not too late to shop for a private plan. If your employer offers a plan, you would need to sign up during open enrollment. But consider your options carefully. Dental insurance is actually not that great - the coverage is not like health insurance.

Why are dentists no longer taking insurance?

Why Some Dentists Stop Participating With Insurance. Most dentists aim to provide the highest quality care to their patients, but sometimes, dental insurance reimbursement rates dont cover the costs of advanced procedures and materials.

Is it too late for my dental health?

No matter how long its been, its never too late to get on track with our oral health.

Security and compliance

At DocHub, your data security is our priority. We follow HIPAA, SOC2, GDPR, and other standards, so you can work on your documents with confidence.

Learn more

Related forms

be ready to get more

Complete this form in 5 minutes or less

Get form

Can I get dental insurance and use it right away?

No. Your coverage starts effective with your contract date, usually, but not always on the first of the month. Especially with dental insurance, people sometimes dont enroll unless there is a problem. In addition to not going retroactive, there may also be a waiting period before benefits are paid.

What happens if you dont have dental insurance?

Public Dental Clinics Many charge low, fixed prices or sliding fees based on how much you can afford. Most clinics offer exams, cleanings, X-rays, root canals, fillings, crowns, and surgical tooth extractions. Some may have emergency dentists on call. Some clinics charge sliding fees based on how much you can afford.

Do any dental plans cover 100%?

Most full-coverage dental plans cover 100% of preventive care. Basic care usually covers simple extractions and fillings, certain types of X-rays and other services like oral cancer testing. Major restorative care includes bridges, crowns, dentures, root canals, complex oral surgeries, and in some cases, implants.

Std 692 2026

Here's how it works