Health insurance comes with a bit of paperwork, but don’t worry — we’re here to break it down for you. Below are five key forms you may need when enrolling in or managing your CaliforniaChoice health benefits.
1: New Hire Enrollment Quote Request
What it is: When you first got hired, you likely filled out this form. It helped generate your personalized health insurance options so you could choose the coverage that works best for you.
Why it matters: This is the first step in getting your health benefits set up!
2: Employee Enrollment Application
What it is: This is the form you complete to officially enroll in CaliforniaChoice coverage, including Medical, Dental, Vision, and Life Insurance.
What to know:
- You’ll need your group number, so check with your HR team.
- Page 5 explains Family Coverage Eligibility Requirements.
- If you previously waived coverage, you might qualify for late enrollment if you’ve lost other coverage.
3: Medical/Dental Waiver
What it is: If you decide to decline Medical and/or Dental coverage, you need to complete this form (page 4 of the Employee Enrollment Application).
Why it matters: Your employer must keep a record of this form for any employees who choose to opt out.
How to submit: You can give it to your HR team or send it directly to CaliforniaChoice by mail, email, or fax (714-558-8000).
4: Change Request Form
What it is: Life happens, and when it does, you may need to update your coverage. This form allows you to make changes due to:
- Marriage or divorce
- Having or adopting a child
- Removing a dependent (like when they turn 26)
- Moving to a new area that’s outside your current plan’s coverage
Timing is key: You typically have 60 days from a qualifying event to make changes. Log in to calchoice.com or call Customer Service (800-558-8003) for details.
5: Employee Termination Notification Form
What it is: If you leave your job or become ineligible for group coverage, your employer must complete this form to remove you from the plan.
Why it matters: This ensures you’re properly transitioned out of the group plan and may help you explore other coverage options like COBRA.
Need Help? We’ve Got You Covered!
All these forms are available online – just log in at calchoice.com or ask your employer for a copy. If you have questions, or you can’t find what you need, contact Customer Service at 800-558-8003 or CustomerService@calchoice.com.
Staying on top of your health coverage is easier than you think — just keep these forms in mind, and you’ll be good to go!