Breadcrumb
PERS Declaration of Health Benefits
Form:
Document
persdeclarationofhealthhbd12a.pdf (744.34 KB)
Department: HR
Format: PDF
Routing Instructions:
Original form to Human Resources
Description:
Complete this form in addition to the HBD-12, Health Benefit Election form. Both forms must be submitted to HR for a benefit transaction to occur.
Category:
Benefit