Every employee must complete a Selection Sheet and CalPERS Declaration of Health Coverage Form (HBD-12A) (even if you don't make a change), along with a copy of the birth certificate and/or marriage certificate to include your spouse or children on your plan. If you have specific questions about the coverage, exclusions or limitations, please contact the carrier, not the District's Accounting Technician-Benefits.
CalPERS HBD-12 & CalPERS HBD-12A are not the same or redundant. HBD12 designates the plan, subscriber and other plan details while HBD12A declares whether or not you (and dependents) are electing to enroll in health coverage.
Please visit the Fiscal Services office at 2730 Del Mar Ave., Rosemead, CA 91770, or contact Maricela Barba, Director of Fiscal Services, at firstname.lastname@example.org or (626) 307-3405 x2551.