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The CALHR 695 form, formally known as the Retiree Vision Plan Enrollment Authorization, is an official document issued by the California Department of Human Resources. It is specifically designed for retirees who want to enroll in a vision insurance plan offered by the state. This form serves as a formal request for enrollment and includes crucial details such as personal information, dependents, and selected coverage options. The primary purpose of CALHR 695 is to ensure that retirees can continue to receive vision care benefits, facilitating access to necessary eye care services.
Using the CALHR 695 form involves a clear understanding of its components and specific instructions for accuracy. First, retirees should carefully fill out all the required fields. Accurate completion of this form is vital to avoid processing delays or errors in coverage.
Retirees can access the CALHR 695 form through multiple channels to accommodate their preferences. The form is typically available via:
Completing the CALHR 695 form requires attention to detail. The following step-by-step process assists in ensuring that the form is filled out correctly:
The CALHR 695 is primarily utilized by retired employees from California state services. These individuals seek to continue their vision care coverage post-retirement. Additionally, family members who are dependents of retirees can be included in the enrollment process, benefiting from extended vision care services.


Understanding specific terminology related to the CALHR 695 form enhances its proper usage and comprehension. Key terms include:
Legally, the CALHR 695 serves as a binding enrollment document, committing the retiree to the terms and conditions of the selected vision plan. It requires accurate and honest representation of information, with implications for coverage if misrepresented.
Several essential components form the core structure of the CALHR 695 form, making it comprehensive for its intended purpose:
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Should you have questions related to enrollment under this program, you may contact CalHR at: (916) 322-0300. CalHR 695. Page 2 of 2. (rev 09/2021)
by DJ La Fetra 2022 Cited by 1 Supp. 3d. 695, 706 (C.D. Cal. 2020) (same). The Supreme Court noted unions disregard for individual em- ployees