Health and Welfare

Required Documents for Enrollment

To Insure Dependent Children

• Birth Certificate
• Social Security Card

To Insure Spouse

• Marriage License
• ID (Drivers License)
• Social Security Card

Enrollment & Cancellation Information

You can request cancellation of coverage at anytime.

To begin coverage outside of open enrollment you must have a loss of coverage letter, to add dependent coverage if you have a permitting event, such as marriage, birth of child etc.

To enroll, add dependent/s, spouse or cancel coverage you must fill out the forms below for your employment classification.

To insure dependent children

• Birth Certificate
• Social Security Card

To insure spouse

• Marriage License
• ID (Drivers License)
• Social Security Card

If you have questions regarding health plans, use this link to the CalPERS web page.

Enrollment forms for medical and dental are below