City Retiree Health Reimbursement Forms

Please use the appropriate form below to request a health insurance reimbursement from SDCERS. After you have filled out the proper form, you can email, mail, or fax the completed form to SDCERS.

Email: (before sending, please read the important security note below. Also, if you are using an Apple product to send the email, in Mail, please select "Format" and click on "Make Plain Text" - we've received reports of emails not getting through our firewalls if this extra step isn't taken when using an Apple product.)

Mail: SDCERS, Attn. Health Reimbursements, 401 West A Street, Suite 800, San Diego, CA 92101 

Fax: (858) 581-5314 

If you plan to send health forms and other confidential information through email (PDF attachments only), read SDCERS' disclosure statement here.

The Health Insurance Portability and Accountability Act of 1996's (HIPPA) Privacy Rule gives SDCERS who receive health coverage the right to be informed of the privacy practices of their health plans, as well as to be informed of their privacy rights with respect to their personal health information. 

As a reminder, SDCERS will not report health reimbursements as taxable income on your 1099-R, so you are responsible for any tax payments the IRS may require from any health insurance reimbursement you receive. If you have any questions about this, please consult a tax professional. SDCERS may not provide tax or legal advice. 

Note: These reimbursements are only available to eligible City of San Diego retirees.