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Add dependent - City of Huntington Beach 2026
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- Click ‘Get Form’ to open it in the editor.
- Begin by selecting the qualifying event that applies to you. Check one box and enter the corresponding date.
- For each dependent you wish to add, fill in their name, relationship, date of birth, and social security number (required for spouse only).
- Indicate which plans you want to add your dependents to by checking the appropriate boxes for Medical, Dental, and Vision.
- If applicable, provide details for additional dependents by repeating steps 3 and 4.
- If you have a name change, ensure to attach a copy of your social security card reflecting the new name.
- Complete any beneficiary changes by checking the relevant boxes and note that forms will be sent through interoffice mail.
- Finally, sign and date the form at the bottom before submitting it.
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| 2010 | 4.8 Satisfied (106 Votes) |
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