Health Service System - City & County of San Francisco

Health Benefits Guide

• Benefits Guide 2008-2009 (pdf)
• Printed Guide 2008-2009 Updates (pdf)

Enrollment Application
HSS members must submit a completed enrollment application and any required documentation to HSS within 30 days of their initial benefits eligibility date and within 30 days of any qualified change in family status.

• Management Cafeteria Plan Enrollment Form (pdf)
• Eligibility Documentation Checklist (pdf)

Healthcare Contributions

• Twice Monthly Rates 2008-2009 (pdf)

Group Life Insurance

• Group Life Policy Summary (pdf)
• Group Life Insurance Beneficiary Designation Form (pdf)

Group Long-Term Disability

• 90-Day Plan Summary(pdf)
• Long-Term Disability Claim Form (pdf)

Flexible Spending Account

• FBMC Flexible Spending Account Reimbursement Claim Form (pdf)
• FBMC Flexible Spending Account Direct Deposit Form (pdf)
• FBMC Flexible Spending Account Eligible Expenses Chart (pdf)

Miscellaneous Reimbursement Account

• Miscellaneous Reimbursement Account Claim Form (doc)