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Attention:

To make a change outside of Open Enrollment, you must notify HR within 60 days of the qualifying event and provide supporting documentation (i.e. marriage certificate to add a spouse, birth certificate to add a baby, et cetera). Supporting documentation can be emailed to Human Resources at HR@tustinca.org.

Thank you,
Human Resources
By continuing I agree that I am willing to complete a digital version of the document(s) and that information about my user session will be stored.
Select a Plan
Enrollee/Change Information
Enrollee Classification
Change Dental Plan
Gender
Marital Status
Cobra
Phone Type
Add/Term_1
Add/Term_2
Add/Term_3
Add/Term_4
Signature HereClick to Sign
04/03/2026Click to Sign
Gender_1
Student/Disabled
Student/Disabled_2
Gender_2
Student/Disabled_3
Gender_3
Student/Disabled_4
Gender_4
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