Pers hbd 12 2013 form-2025

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The document is a Health Benefit Plan Enrollment Form for the California Public Employees' Retirement System (CalPERS). It outlines the process for employees to enroll, change, or cancel their health coverage, requiring personal information such as Social Security numbers, dates of birth, and health plan details. The form also includes privacy information regarding the use of personal data and mentions binding arbitration for medical malpractice issues.

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Versions	Form popularity	Fillable & printable
2018	4.8 Satisfied (81 Votes)
2013	4.3 Satisfied (98 Votes)
2010	4.9 Satisfied (51 Votes)
2002	4.4 Satisfied (318 Votes)

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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.

Who completes the health and dental enrollment form?

All benefit-eligible employees should complete an enrollment form, whether the employee is electing or waiving the benefit.

What is CalPERS death benefit package?

The benefits payable depend on a number of factors such as the members age, years of service, eligible beneficiary, and whether or not the employee was eligible to retire at the time of death (age 50 with at least five years of service credit).

What is the average CalPERS monthly pension?

If you enter into employment with a reciprocal retirement system, the California State Teachers Retirement System (CalSTRS), the Judges Retirement System (JRS), the Judges Retirement System II (JRS II), or the Legislators Retirement System (LRS) within six months of leaving your CalPERS-covered employment, you are

What is HBD 12?

Health Benefits Plan Enrollment for Active Employees (HBD-12) Instructions. Page 1. State of California. California Public Employees Retirement System. .calpers.ca.gov.

What is CalPERS HBD 12?

To enroll or decline enrollment in the CalPERS Health Program or to make changes to your health plan, you must submit an HBD-12 form to your Health Benefits Officer (HBO).

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