Enrollment and Change Forms

• Enroll or make changes to your CalPERS medical plan, and complete the PERS HBD-12 Enrollment form within 30 days from the date of hire, or qualifying life event.
• Enroll in or make changes to the City’s voluntary life and AD&D insurance, select and complete the Standard Life & AD&D enrollment/change form listed below within 30 days from the date of hire, or qualifying life event.
• Enroll in the City’s Flexible Spending Accounts (FSA) for either Health and/or Dependent Care, select and complete the Flexible Spending Account form within 30 days from the date of hire, or qualifying life event.

• CalPERS HBD-12 Medical Enrollment/Change form
• Dental & Vision Enrollment/Change form
• Flexible Spending Accounts Form
• Standard Voluntary Additional (Supplemental) Life Insurance Form  

All above forms are fillable online and once completed, sign and email to benefits@cityofmarina.org.