Contents
Cal Poly Pomona

How to Enroll in Benefits

Step-By-Step Guide

Step 1

Answer these three (3) questions before proceeding to the next step.

  1. Are you eligible for benefits?
  2. Are your family members eligible for benefits?
  3. Do you need to attend a New Employee Benefits Orientation?

Step 2

Read the information on When You Can Enroll

Step 3

View your New Employee Benefits Packet and the Benefits Information on our Website.

Step 4

Decide which medical and dental plans to enroll in or whether you will be enrolling in FlexCash in lieu of Medical and/or Dental (depending on your eligibility for FlexCash).

Step 5

Complete Benefits Enrollment Worksheet.

To request enrollment or an enrollment change, please complete the Enrollment Worksheet (PDF) and Declaration of Health Coverage (PDF), and return both forms to Benefits Services, located in the Human Resources Department at Cal Poly Pomona, CLA Building 98, Room B1-20.

Additional documentation may be required in support of including (or adding) eligible family members in your health plan enrollment. Please see Eligible Family Members for details.

Step 6

Review Optional Benefits and Enroll During Initial 60-Day* Enrollment Period, if applicable.**

*31-Day Initial Enrollment Period for Sanders & Associates Voluntary Insurance Programs.

**Enrollment is optional. Program deadlines vary.

Step 7

Review and sign your Enrollment Forms with Human Resources:

  • Medical (HBD-12);
  • Dental (STD 692); and/or
  • FlexCash Enrollment Authorization (if waiving medical or dental due to other coverage)

Step 8

Step 9

Step 10

Contact Medical Plan if you do not receive your Identification Card(s) within eight (8) weeks of enrollment.

Step 11