Enrollment Forms

DocuSign Forms

CalPERS HBD-12

Health Insurance Waiver & Annual Certification

Dental/Vision Enrollment Form

Beneficiary Designation Form

Supplemental Enrollment and Beneficiary Form

2022 D-Care Enrollment Form

2022 H-Care Enrollment Form

2022 FSA Enrollment Form

Affidavit of Domestic Partnership

Statement of Termination of Domestic Partnership

Direct Pay Reimbursement Form

457 Deferred Compensation Deduction Form

Downloadable Forms

457 Deferred Compensation Deduction Form

CalPERS HBD-12

HBD-12 Completion Instructions

Health Insurance Waiver & Annual Certification

Dental/Vision Enrollment Form

2022 H-Care Enrollment Form

2022 D-Care Enrollment Form

D-Care Reimbursement Account Claim Form

2022 FSA Enrollment Form

PayFlex Claim (FSA) Reimbursement Form

Affidavit Parent-Child Relationship

Affidavit of Domestic Partnership

Statement of Termination of Domestic Partnership

Direct Pay Reimbursement Form

Supplemental Enrollment and Beneficiary Form