Plan Documents

 
Title Date Sort ascending
2019 Delta Dental PPO SmileWay Flyer for Retirees
City & County of SF Employees, Municipal Executive Employees, Retirees, Getting Ready to Retiree, Retirees with Medicare, Retirees without Medicare, Superior Court of SF Employees, 2019
January 10, 2019 Download
2019 Delta Dental PPO SmileWay Flyer for Active Employees
City & County of SF Employees, Municipal Executive Employees, Retirees, Getting Ready to Retiree, Retirees with Medicare, Retirees without Medicare, Superior Court of SF Employees, 2019
January 10, 2019 Download
2019 Domestic Partner Declaration Form
City & County of SF Employees, SF Unified School District Employees, City College of SF Employees, Municipal Executive Employees, Retirees, Getting Ready to Retiree, Retirees with Medicare, Retirees without Medicare, Superior Court of SF Employees, 2019
January 3, 2019 Download
SFHSS Auto-Pay Form
City & County of SF Employees, SF Unified School District Employees, City College of SF Employees, Retirees, Getting Ready to Retiree, Retirees with Medicare, Retirees without Medicare, Superior Court of SF Employees, 2019
January 3, 2019 Download
2019 Evidence of Coverage (EOC) Kaiser Permanente Senior Advantage HMO Washington (Medicare)
Retirees, Getting Ready to Retiree, Retirees with Medicare, Kaiser Permanente HMO, Kaiser Permanente Senior Advantage HMO - Multi-Region, 2019
January 2, 2019 Download
2019 Evidence of Coverage (EOC) Kaiser Washington (Non-Medicare)
Retirees, Getting Ready to Retiree, Retirees without Medicare, Kaiser Permanente HMO, Kaiser Permanente HMO - Multi-Region, 2019
January 2, 2019 Download
2019 Form Live or Work Enrollment Form
City & County of SF Employees, Municipal Executive Employees, 2019
December 28, 2018 Download
2019 SFUSD Premium Rates
SF Unified School District Employees, 2019
December 28, 2018 Download