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Sfhss open enrollment application 2026

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The document is an enrollment application for the San Francisco Health Service System (SFHSS) for the 2020 plan year. It outlines the requirements for employees to change their medical or dental elections, add or drop dependents, and enroll in Flexible Spending Accounts (FSA). The form must be submitted by October 31, 2019, along with necessary eligibility documentation. It includes sections for personal information, selection of medical and dental plans, and a certification statement regarding the accuracy of the provided information.

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Click ‘Get Form’ to open the sfhss open enrollment application in the editor.
Begin by filling out your personal information in Section 1. Include your last name, first name, address, social security number, gender, birth date, email address, and phone numbers.
In Section 2 and Section 3, select your preferred medical and dental plans from the provided options. Ensure you understand any eligibility requirements for each plan.
If applicable, list any dependents you wish to add or drop in Section 5. Provide their names, birth dates, gender, and social security numbers as required.
For Flexible Spending Accounts (FSA), indicate your desired contributions in Section 6. Remember to check the minimum and maximum contribution limits.
Finally, review all entered information for accuracy before signing and dating the form in Section 7. This step is crucial for ensuring compliance with SFHSS regulations.

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Versions	Form popularity	Fillable & printable
2020	4.8 Satisfied (145 Votes)
2018	4.4 Satisfied (102 Votes)

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

How to apply for a San Francisco health plan?

Visiting Our Service Center Our Enrollment Team offers information and application assistance for Medi-Cal. Our team is happy to assist you with health coverage needs at a time that works best for you! To schedule an in-person or phone appointment, please contact us at 1(415) 777-9992 or 1(888) 558-5858.

How to enroll in San Francisco health Plan?

Contact our Enrollment Team by calling 1(888) 558-5858 Monday Friday, 8:30am to 5:30pm. Asking a member of our Enrollment Team is the best way to know for sure if you qualify for one of our health care coverage programs.

How to apply for Healthy SF?

To apply for Healthy San Francisco, you will need to meet with a program Application Assistor. You will be asked to provide documents such as personal identification, proof that you live in San Francisco, and proof of your family income and assets.

Is San Francisco Health Plan the same as Medi-Cal?

Book your appointment online with an enroller at the SFHP Service Center. Call toll-free at 1(800) 288-5555 or 1(415) 547-7830 (TTY), MondayFriday, from 8:30am5:30pm to schedule an in-person or phone appointment.

What is the open enrollment process?

An open enrollment period is a window of time that happens once a year typically in the fall when you can sign up for health insurance, adjust your current plan or cancel your plan.

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How long is open enrollment for most employees?

Open enrollment is not required to be a certain length of time. Most employers have an open enrollment period of at least two to four weeks. Need help defining health benefit terms to employees?

What is open enrollment for FSA?

Open Season is the period of time in which eligible employees can enroll in an FSA offered through FSAFEDS. Its always held concurrently with the Federal Benefits Open Season from mid-November to mid-December. Enrollment in an FSA is completely voluntary.