Free Lausd Hi 22 PDF Template

1. What is the HI-22 form for the Los Angeles Unified School District?

   The HI-22 form is an important document for employees of the Los Angeles Unified School District who are nearing retirement. It serves as an application for the continuation of health benefits into retirement. Employees are advised to complete this form at least three months before their retirement date to ensure a smooth transition of their health benefits. It allows retirees to select their desired medical, dental, and vision plans from the options available to them at the time of retirement.

2. Who needs to fill out the HI-22 form?

   Any employee of the Los Angeles Unified School District planning to retire should fill out the HI-22 form if they wish to continue receiving health benefits after retirement. This includes both those planning for service retirement and those retiring due to disability. The form must be submitted along with any required documentation, such as a copy of the Medicare card if applicable, to ensure continued coverage.

3. What are the key sections of the HI-22 form?

   The HI-22 form includes several key sections:

   • Personal Information: Includes basic details such as employee number, name, address, and contact information.
   • Retirement Details: Employees specify their retirement type (service or disability) and provide retirement dates.
   • Health Plans: Applicants select their preferred medical, dental, and vision insurance plans from the options provided.
   • Dependent Information: Details about dependents needing coverage must be provided, including their social security numbers and relation to the retiree.
   • Medicare Information: Mandatory for employees or their dependents aged 65 or older; a copy of the Medicare card must be attached.
   It also includes a section for acknowledging understanding and agreement with the terms for enrollment in the selected plans.

4. How do employees select their health benefits on the HI-22 form?

   On the HI-22 form, employees retiring from the Los Angeles Unified School District can select their health benefits by marking their choices in the provided sections for medical, dental, and vision plans. Each section lists different health plan options available for retirees, including plans for those under and over the age of 65. It is important for retirees to review each plan option carefully to determine which best meets their needs and the requirements of their dependents.

5. What happens after the HI-22 form is submitted?

   After submitting the HI-22 form, the Benefits Administration team at the Los Angeles Unified School District processes the application. Retirees should forward any additional required documents, such as the "Notice of Benefit Approval" from their retirement system, to the administration. The retiree's health benefits status will remain pending until all necessary documentation is received and processed. Once approved, retirees will be enrolled in their selected health plans and will receive confirmation of their benefits coverage. To avoid any disruption in coverage, it is important to notify the Benefits Administration of any changes in address or eligibility of dependents.

When filling out the Los Angeles Unified School District (LAUSD) HI-22 form for the continuation of health benefits, it's crucial to avoid common mistakes that can lead to complications or delays in the processing of retirement benefits. Understanding these common errors can help ensure the process is smooth and efficient.

1. Not submitting the form in time: Failing to complete and submit the HI-22 form at least three months before retirement can delay the activation of benefits.

2. Inaccurate or incomplete personal information: Providing incorrect details such as name, social security number, address, or phone number, or leaving mandatory fields blank, can result in the rejection of the application.

3. Incorrect retirement date information: Entering wrong dates or not specifying the type of retirement (Service Retirement or Disability Retirement) can lead to issues in determining eligibility and effective coverage dates.

4. Failing to select health plans appropriately: Not clearly indicating the medical, dental, and vision plans or overlooking the specific requirements for each selected plan, especially for retirees and/or dependents over 65 or those with particular Medicare needs, could mean not being enrolled in the desired plan.

5. Omitting dependent information: Neglecting to provide necessary details for all dependents, including their social security numbers and proof of Medicare enrollment for those who are eligible, can cause delays or denial of coverage for dependents.

6. Not providing required documentation: Failing to attach a copy of the Medicare card for those age 65 or older, or not forwarding the "Notice of Benefit Approval" from the retirement system, can keep the application pending and halt the benefits process.

Each of these mistakes can be avoided by carefully reviewing the form, meticulously completing each section, and ensuring all required documents are attached before submission. The key to a successful submission is attention to detail and adherence to the guidelines provided by the LAUSD Benefits Administration.

When you're completing the Los Angeles Unified School District (LAUSD) HI-22 form for the continuation of health benefits upon retirement, there are several additional forms and documents that you often need to gather and submit to ensure a smooth transition. This process requires careful attention to detail to ensure that all information is accurate and submitted on time.

• Notice of Benefit Approval or Award Letter: This document is issued by your retirement system—either the California State Teachers Retirement System (CalSTRS) or the Public Employees' Retirement System (CalPERS). It confirms your retirement status and the commencement of your retirement benefits. Benefits Administration requires a copy of this document to process your health benefits continuation.
• Medicare Card: For retirees and/or their dependents who are age 65 or older, a copy of the Medicare card is mandatory. This card provides proof of enrollment in both Medicare Parts A and B, which is a requirement for certain health plans specified in the HI-22 form.
• Proof of Dependent Eligibility: If you are adding dependents to your plan, you might need to provide documents verifying their relationship to you and their eligibility for coverage. This could include birth certificates, marriage certificates, or domestic partnership registrations.
• Change of Address Form: Should you move after submitting the HI-22 form, it's crucial to notify Benefits Administration of your new address. A specific form or written notice may be required to ensure you continue to receive important benefits information without interruption.

Collecting and completing these documents is a key step in ensuring that your health benefits transition smoothly into retirement. Always double-check with LAUSD Benefits Administration for any changes to the required documents or if additional information is needed. This proactive approach helps protect your access to health benefits during this significant life transition.

• Employee Enrollment Form: This document is used by new or existing employees to enroll in various employer-provided benefits. It resembles the LAUSD HI-22 form in function by allowing employees to select from available health plans. However, it’s usually for active employees rather than retirees.
• Medicare Enrollment Form: Like the HI-22, this form is used for enrolling in healthcare coverage, specifically Medicare. The similarity lies in the requirement for individuals over 65 or those with certain disabilities to fill out this form to receive benefits. Both forms require personal information and health plan selection based on eligibility.
• Change of Beneficiary Form: This document allows individuals to designate or change the beneficiary(ies) for their insurance policies or retirement accounts. While it focuses on beneficiaries rather than healthcare enrollment, it shares the necessity of providing accurate personal and dependent information, mirroring the dependent information section of the HI-22 form.
• COBRA Election Form: COBRA provides former employees and their families the right to choose to continue group health benefits provided by their group health plan under certain circumstances. The election form and the HI-22 form are similar because both involve making decisions about continuing healthcare coverage post-employment.
• Life Insurance Application: This document is typically filled out when applying for life insurance, requiring the applicant to provide personal information and, in some cases, information about their dependents. The process of selecting coverage options and listing dependents is akin to parts of the HI-22 form’s functionality in the healthcare domain.
• Disability Claim Form: Used for individuals to claim disability benefits, this form requires detailed personal information, medical history, and current medical condition, similar to sections of the HI-22 form that deal with retirement due to disability and choosing appropriate healthcare plans.
• Retirement Plan Beneficiary Designation Form: This allows individuals to nominate beneficiaries for their retirement accounts. It’s akin to the HI-22 form as both involve planning for future benefits and necessitate updating personal and dependent information.
• Flexible Spending Account (FSA) Enrollment Form: An FSA enrollment form lets employees allocate a portion of their earnings to cover medical expenses tax-free. Like the HI-22 form, it involves making decisions about healthcare-related benefits and requires personal and eligibility information.
• Retirement Application Form: Similar to the HI-22, a retirement application form is completed by employees planning to retire. It includes personal information, retirement plan selection, and often requires decisions about post-retirement benefits, including health insurance.
• Health Insurance Portability and Accountability Act (HIPAA) Authorization Form: This legal document allows an individual’s health information to be used or shared for specified purposes. While primarily focused on privacy and information sharing, its need for detailed personal and health information aligns with aspects of the HI-22 form’s data collection for health plan administration.

When filling out the Los Angeles Unified School District (LAUSD) HI-22 form for continuation of health benefits upon retirement, there are certain dos and don'ts that can help streamline the process and ensure accuracy. Below is a guide to assist you:

• Start early: Complete the form at least 3 months before your retirement date to avoid any delays in benefit continuation.
• Verify your information: Double-check your Employee Number, Social Security Number, and personal details to ensure they are accurate.
• Select the correct health plans: Carefully read the health plan options and choose the one that aligns with your needs, especially considering your age and Medicare enrollment status.
• Include dependent information: If you have dependents, provide all mandatory details, including their Social Security numbers.
• Attach Medicare documentation: If you or your dependents are over 65, attach a copy of the Medicare card as required.
• Provide retirement system documentation: Forward a copy of your “Notice of Benefit Approval” (PERS) or “Award Letter” (STRS) to Benefits Administration as soon as you receive it.
• Sign and date the form: Your signature is required to process the application. Confirm that all information is true to the best of your knowledge.

• Write in shaded boxes: The shaded areas are for administration use only and should be left blank.
• Delay in notifying changes: Inform the Benefits Administration immediately if there are any changes in your or your dependents’ eligibility.
• Assume enrollment: Do not presume you are enrolled in a plan without receiving confirmation. Always double-check your enrollment status.
• Forget about Medicare requirements: Failure to enroll in Medicare Parts A & B when eligible could result in a loss of benefits.
• Ignore life insurance options: Be aware of your life insurance conversion options upon retirement and act within the designated time frame.
• Miss out on FSA claims: If you have a Flexible Spending Account, remember you have 90 days post-employment to submit claims.
• Change address without notification: Always update your address with the Benefits Administration to ensure you receive all pertinent information.

When it comes to navigating retirement and benefits forms such as the Los Angeles Unified School District (LAUSD) HI-22 form, it's easy to come across misleading or confusing information. Below are seven common misconceptions about the LAUSD HI-22 form and clarifications to help understand the form better.

• It's unnecessary to complete the form before retirement.

  Contrary to this belief, it is crucial to complete the HI-22 form at least three months before retirement. This timeframe helps ensure a smooth transition to retirement health benefits.

• You can only select health plans you’re currently enrolled in.

  This misconception can limit options unnecessarily. Retirees can choose any available plan at the time of retirement, not just the ones they were previously enrolled in.

• Submission of the Medicare card is optional.

  For retirees or their dependents aged 65 or older, submitting a copy of the Medicare card is mandatory, not optional. This requirement ensures that Medicare information is accurately integrated with the chosen health plans.

• Dependent information is optional.

  Providing dependent information, including their Social Security numbers, is mandatory if they are to be included under the retiree's benefits. Without this information, dependents cannot be properly enrolled.

• The form is only for medical coverage election.

  The HI-22 form is not limited to selecting medical coverage but also includes options for dental and vision care plans, allowing for comprehensive benefits coverage upon retirement.

• Filling out the shaded boxes is necessary.

  Applicants are instructed not to write in the shaded boxes. These sections are reserved for administrative use and processing.

• Life insurance conversion is automatically processed.

  Upon retirement, converting life insurance plans is an available option, but action is required by the retiree. Information and applications for conversion will be mailed, but it is up to the retiree to follow up.

Understanding the HI-22 form thoroughly by debunking these misconceptions ensures a smoother transition into retirement, with benefits correctly aligned to the retiree's needs and circumstances. Getting the details right can significantly impact the quality and coverage of one's retirement health benefits.

Understanding the Los Angeles Unified School District's HI-22 form is crucial for employees approaching retirement. Here are seven key takeaways that will guide you through filling out and using the form effectively:

• Timely Submission: To ensure a smooth transition into retirement, submit the application at least 3 months before your retirement date. This lead time is crucial for processing your health benefits without interruption.
• Health Plan Selections: The HI-22 form allows retirees to choose from various health plans, including medical, dental, and vision options. Select the plans that best fit your needs in retirement, considering factors like your age and whether you’re enrolled in Medicare Parts A & B.
• Medicare Compliance: If you or your dependents are 65 or older, enrollment in Medicare Part B is mandatory to maintain your health benefits. Additionally, verify your Medicare Part A status to ensure compliance and avoid any impact on your health coverage.
• Dependent Information: For all dependents you wish to include in your coverage, providing their Social Security number is a must. It’s important to keep the District updated on any changes in your dependents' eligibility to avoid issues with premiums and claims.
• Required Documentation: Along with the HI-22 form, submitting a copy of your and your dependents’ Medicare card(s) is necessary if applicable. Also, remember to send in the “Notice of Benefit Approval” from your retirement system to activate your benefits.
• Retirement Eligibility: Your eligibility for retiree health benefits heavily depends on your hire date, years of service, and retirement plan selection. Understanding these requirements will help you determine your eligibility for continued health benefits.
• Keeping LAUSD Informed: Any change in your address or personal circumstances should be promptly communicated to the Benefits Administration. This will ensure you receive all relevant benefits information and prevent any possible loss of benefits.

By keeping these key points in mind when completing the HI-22 form, Los Angeles Unified School District employees can navigate the process of securing health benefits into retirement more confidently and efficiently.