Health Service System Benefits Guides are available online at sfhss.org. You may request a paper guide by completing the form below. We try to respond promptly to requests. Guides will be mailed within one business day of your request being received. NOTE: Plan Year 2019 guides are not yet available.  Guides will begin shipping the week of October 9th.  If you need assistance completing this form call Member Services at 1-415-554-1750.

Which type of HSS member are you?

Question Title

1. Which type of HSS member are you?

What is your 6 digit employee ID number?

Question Title

2. What is your 6 digit employee ID number?

Please provide the address where you would like your Benefits Guide to be mailed:

Question Title

3. Please provide the address where you would like your Benefits Guide to be mailed:

What is your phone number?
HSS may contact you if there is a question about this request.

Question Title

4. What is your phone number?
HSS may contact you if there is a question about this request.

What is your email address?
HSS may contact you if there is a question about this request.

Question Title

5. What is your email address?
HSS may contact you if there is a question about this request.

T