Declaration of Health Coverage HBD-12A - calpers ca 2025

Get Form
Declaration of Health Coverage HBD-12A - calpers ca Preview on Page 1
4.2 out of 5
29 votes
DocHub Reviews
44 reviews
DocHub Reviews
23 ratings
15,005
10,000,000+
303
100,000+ users

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.

The best way to edit Declaration of Health Coverage HBD-12A - calpers ca in PDF format online

Form edit decoration
9.5
Ease of Setup
DocHub User Ratings on G2
9.0
Ease of Use
DocHub User Ratings on G2

Working on paperwork with our feature-rich and intuitive PDF editor is simple. Make the steps below to complete Declaration of Health Coverage HBD-12A - calpers ca online quickly and easily:

  1. Log in to your account. Log in with your credentials or register a free account to test the product before upgrading the subscription.
  2. Import a document. Drag and drop the file from your device or import it from other services, like Google Drive, OneDrive, Dropbox, or an external link.
  3. Edit Declaration of Health Coverage HBD-12A - calpers ca. Easily add and highlight text, insert pictures, checkmarks, and signs, drop new fillable areas, and rearrange or remove pages from your document.
  4. Get the Declaration of Health Coverage HBD-12A - calpers ca completed. Download your updated document, export it to the cloud, print it from the editor, or share it with other participants through a Shareable link or as an email attachment.

Make the most of DocHub, one of the most easy-to-use editors to quickly handle your paperwork online!

Fill out Declaration of Health Coverage HBD-12A - calpers ca online
It's free
Start now

See more Declaration of Health Coverage HBD-12A - calpers ca versions

We've got more versions of the Declaration of Health Coverage HBD-12A - calpers ca form. Select the right Declaration of Health Coverage HBD-12A - calpers ca version from the list and start editing it straight away!
Versions Form popularity Fillable & printable
2015 4.9 Satisfied (498 Votes)
2009 4.2 Satisfied (29 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.
Contact us
Health Insurance. The state may pay up to 100 percent of the premiums depending on the plan selected. If you already have qualifying medical and/or dental coverage through another source, such as a spouse, you can receive cash in lieu of your health and/or dental coverage.
Eligibility Enrollment (Retiree) An employee may continue health coverage upon retirement if certain requirements are met. Details about enrollment, cancellation, and making changes to your plans can still be made in myCalPERS.
Health and Well-Being The state may pay up to 100 percent of the premiums depending on the plan selected. If you already have qualifying medical and/or dental coverage through another source, such as a spouse, you can receive cash in lieu of your health and/or dental coverage.
Who is eligible? Qualify for Medi-Cal if your income is up to 138 percent of the Federal Poverty Level (FPL) for adults, and up to 266 percent FPL for children. Check Shop and Compare to see if you qualify. Learn more on the Department of Health Care Services website.
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).

Related Searches

Declaration of health coverage hbd 12a calpers ca sample Declaration of health coverage hbd 12a calpers ca form

Related forms

Form preview
Verification of Railroad Retirement Benefits - TSI Form 1026-TSI
Learn more
Verification of Railroad Retirement Benefits - TSI Form 1026-TSI
The document is a request for information from the Railroad Retirement Board regarding an individual's retirement benefi ...
Learn more
Form preview
Chair, Dallas - dads state tx
Learn more
Chair, Dallas - dads state tx
The document outlines changes to the approval process for adaptive aids and medical supplies under the Texas Department ...
Learn more
Form preview
2422 doc Contact Memo for Federal SandC Letter No 05-08 - Clarification of Survey Agency Responsibil
Learn more
2422 doc Contact Memo for Federal SandC Letter No 05-08 - Clarification of Survey Agency Responsibil
The document is a case closure form for the Medically Dependent Children Program (MDCP) from the Texas Department of Agi ...
Learn more
Form preview
2004-14 - The Texas Department of Aging and Disability Services - dads state tx
Learn more
2004-14 - The Texas Department of Aging and Disability Services - dads state tx
The memorandum from the Department of Aging and Disability Services (DADS) outlines the procedures for notifying law enf ...
Learn more
Form preview
Assistant Deputy Commissioner
Learn more
Assistant Deputy Commissioner
This memorandum from the Texas Department of Human Services outlines recent legislative changes to the Texas Health Step ...
Learn more
Form preview
Authorization for Use of State Aircraft - The Texas Department of
Learn more
Authorization for Use of State Aircraft - The Texas Department of
The document is a Form 4183 from the Texas Department of Aging and Disability Services, used to authorize the use of sta ...
Learn more
Form preview
TEXAS DEPARTMENT OF AGRICULTURE Application For - texasagriculture
Learn more
TEXAS DEPARTMENT OF AGRICULTURE Application For - texasagriculture
The document is an application form for a Vegetable Seed License from the Texas Department of Agriculture, requiring app ...
Learn more
Form preview
Instructions for egg labeling exemption application form no reg-201 - texasagriculture
Learn more
Instructions for egg labeling exemption application form no reg-201 - texasagriculture
The document provides instructions for completing the Egg Labeling Exemption Application Form No. REG-201 in Texas. It o ...
Learn more
be ready to get more

Complete this form in 5 minutes or less

Get form

People also ask

California State employees receive a number of highly competitive benefits, including: California Public Employees Retirement System (CalPERS) pension. 401(k) and 457 plans. Health. Dental. Vision. Leave benefits and paid holidays. Flexible schedule. Telework.
A certificate of coverage (CoC) is a contract that lists an individuals health insurance coverage with their payor. The CoC details the health benefits the beneficiary and their dependents have under their plan.
The Federal Employees Health Benefit (FEHB) program offers federal employees a choice of multiple health insurance plans at a reduced rate and paid with pre-tax dollars. The U.S. Government pays 72-75% of the premiums for each plan and employees are responsible for the remainder of the premium.

Related links

Declaration of Health Coverage Form (HBD-12A)

If you are not eligible to be enrolled in a CalPERS-sponsored health plan on the date you separate employement, you will not be eligible for health benefits

Learn more

Try more PDF tools

Edit & Annotate
Edit PDF
Add Fillable Fields
Create PDF
Insert and Merge
Add Page Numbers
Rotate Pages
Delete Pages
Convert
Word to PDF
TXT to PDF
HTML to PDF
CSV to PDF
PPT to PDF
RTF to PDF
JPG/JPEG to PDF
PNG to PDF
Collaborate & Share
Add Comments
Fax
PDF Status
Sign & Send
Sign a PDF
Send for Signing
Protect PDF
Set PDF password
Readable PDF
Certify PDF
PDF Audit Trail
Others
Search for PDF
Export
Download
Flatten Fields
Print out
If you believe that this page should be taken down, please follow our DMCA take down process here
support@dochub.com
17 Station St., Ste 3 Brookline, MA 02445
Google Play App Store
© 2025 DocHub, LLC
Products
PDF Editor
Forms & Templates
Sign Documents
Server Status
Pricing
Forms Library
Features
Functions
Company
About
Terms
Privacy Notice
Legal
Patents
Support
Release Notes
Resources
pdfFiller
US Legal Forms
Electronic Signature
No-code document workflows
DocHub Mobile App
What's New
New
DocHub v6 Released! Multi-file envelopes, bulk file importing, and multi-page reordering and much more.
Contact us
support@dochub.com
17 Station St., Ste 3 Brookline, MA 02445
Google Play App Store
© 2025 DocHub, LLC
This site uses cookies to enhance site navigation and personalize your experience. By using this site you agree to our use of cookies as described in our Privacy Notice. You can modify your selections by visiting our Cookie and Advertising Notice.... Read more...Read less
Accept