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Employee Benefits Navigation
Benefits Home
Employee Benefits Home
Health Plans
Rate Sheets
Enrollment Forms
Dental / Vision
Employee Assistance Program
125 Pre Tax Programs
Life Insurance
Disability
Retirement
Enrollment Forms
DocuSign Forms
CalPERS HBD-12
Health Insurance Waiver & Annual Certification
Dental/Vision Enrollment Form
Beneficiary Designation Form
Supplemental Enrollment and Beneficiary Form
2021 D-Care Enrollment Form
2021 H-Care Enrollment Form
2021 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
2021 H-Care Enrollment Form
2021 D-Care Enrollment Form
D-Care Reimbursement Account Claim Form
2021 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