Please pass this form along to any employees you are aware of whose benefits have been erroneously terminated or changed or for employees who have not been able to enroll in their benefits! We will be working with the city's Health Services System to do all reinstatements and activations of benefits within 1 - 2 weeks of form submission.

In the meantime, we encourage eligible employees to access health care as needed as all expenses will be reimbursed. Additionally, if an employee has a major medical emergency, please call the Call Center at (415-463-1550) for immediate escalation to the Case Management Team.  This will be the fastest way to resolve emergencies. 

Benefits Reinstatement and Activation Form