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Kern County is actively responding to COVID-19.  Visit the dashboard for updated information.

 

Retiree Forms

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WARNING:  PROTECT YOUR PRIVATE HEALTH INFORMATION (PHI)!
DO NOT email or fax completed forms. 

NOTE:  Original signature required on forms and electronic submissions of forms will NOT be processed.

Instructions:

  1. Print form(s)
  2. Complete
  3. Return original to:  Kern County Health Benefits

Retiree Forms

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