Benefits Paperwork – New-To-State Employee
Complete all applicable documents.
Questions will be addressed during On-Boarding with Benefit Staff Member.
- Dental Plans for Active Employees Directory of State-Sponsored Dental Plans
- 2022 Consolidated Benefits Handbook
- 2021 Summary of Benefits and Coverage Notice
- Affidavit of Parent-Child Relationship (CalHR 025)
- Affidavit of Parent-Child Relationship (HBD-40)
- Affordable Care Act Notification
- Basic Group Term Life Insurance for Excluded Employees
- California State Employee Benefits Quick Reference Guide
- CalPERS 2021 State Health Premiums Rates (Actives and Annuitants)
- CalPERS Beneficiary Designation (PERS-BSD-241)
- Cash Option Enrollment Authorization (STD. 701C)
- CCPOA Benefit Trust Fund Primary Dental Plan (Bargaining Unit 6 employees only)
- Consolidated Benefits (COBEN) (Information)
- Consolidated Benefits (COBEN) Cash Enrollment Election (STD. 702) (Bargaining Units 2, 7, 8, 16, 17, 18, or 19 and Excluded)
- Dental Benefits Handbook
- Dental Plan Enrollment Authorization (STD. 692)
- Dental Program (Information)
- Dependent Eligibility Verification Checklist (CalHR 781)
- FlexElect Handbook – CalHR
- FlexElect Reimbursement Claim Form (CalHR 351)
- Group Legal Services Insurance Plan Enrollment Form – Access Code 10202soc
- Health Benefit Plan Enrollment Form (PERS-HBD-12)
- Health Program Guide
- Lactation Accommodation Employee Acknowledgement (CDCR 1135)
- Life Insurance Enrollment Form (STD. 698)
- Physician Designation (Page 7)
- Premier Vision Plan Enrollment Authorization (CalHR 774)
- Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP)
- Reimbursement Account Enrollment Authorization (STD. 701R)
Benefits forms for Managers, Supervisors, and Exempt
- CalHR State of California Supervisor Handbook (Managers and Supervisors)
- Compensation Plus Handbook (Managers, Supervisors, Confidential, and Excluded)
- Employee Assistance Program Supervisor Handbook (Managers and Supervisors)
- Group Long Term Disability (LTD) – Excluded State Employees Only (Information) To enroll visit The Standard Insurance Company website and select the Enroll Now.
Revision 09/2021