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Administration & Finance

Human Resources

Visit the Human Resources Virtual Front Desk. Hours: Mon- Fri, 10am - 1pm

Human Resources front desk is now located at Building 1, Room 222.

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Current: Declaration of Health Coverage (HBD-12A)

Declaration of Health Coverage (HBD-12A)

As part of any health plan enrollment or change, you are required to complete/submit a CalPERS Declaration of Health Coverage (HBD12-A)

Launch the Declaration of Health Coverage Form

Applicant Instructions

After launching the CalPERS Declaration of Health Coverage (HBD-12A), a DocuSign PowerForm will prompt you for your name and email.
Complete all required fields
The following information is needed to complete the CalPERS Declaration of Health Coverage (HBD-12A)
- Employee Information: Name and social security number