1. 2020 Employee Benefits Information
2. 2019 Employee Benefits Information
3. Health Benefits Enrollment Form - Active Employees
4. Unit F and Unit G Benefits Overview
5. 2020 Health Benefits Enrollment Form - Half-Time Active Employees
6. Request for Change of Dependent Status - Active Employees
7. 2020 Domestic Partner Information, Declaration, and Enrollment Form
8. Change of Address Form
9. Update Your Personal Information
10. Retirement Eligibility Verification Form
11. 2020 Medical Opt-Out Cash Back Attestation Form
12. 2019 Medical Opt-Out Cash Back Attestation Form
13. 2019-20 Unit F - Benefits Opt-Out Cash Back Attestation Form
14. Mid Year Plan Changes
15. Application for Retiree Health Benefits HI-22 Form

 

1. 2020 Retiree Benefits Guide
2. 2019 Retiree Benefits Guide
3. Request for Change of Dependent Status - Retirees
4. Application for Retiree Benefits HI-22 Form
5. Change of Address Form HBR10
6. 2020 Domestic Partner Information, Declaration, and Enrollment Form
7. Mid Year Plan Changes

 

 2020 COBRA Active Employees 2019 COBRA Active Employees
 2020 COBRA District Retirees 2019 COBRA District Retirees
 2020 Cal-COBRA 2019 Cal-COBRA
 2020 AB528 2019 AB528
 2019-20 COBRA Active Unit F & Unit G 2018-19 COBRA Active Unit F & Unit G
   
  MetLife
1. Enrollment Form 
2. Beneficiary Designation Form
3. Plan Benefits - At a Glance
4. MetLife Advantages - Additional No Cost Services Flyer
5. Statement of Health Form 
1. 403(b) Flyer
2. 403(b) List of Vendors
3. 403(b) Plan Information
4. 457(b) Flyer
5. 457(b) Enrollment Form
6. 457(b) Plan Information
   
1. 2020 Flexible Spending Account Newsletter
2. 2019 Flexible Spending Account Newsletter
3. 2020 FSA Enrollment Form
4. 2019 FSA Enrollment Form
5. FSA Request for Change Form
6. Health Care FSA - How to Submit a Claim Instructions
7. Dependent Care FSA - How to Submit a Claim Instructions
8. ConnectYourCare Mobile
9. Online Account Portal Overview

 

1. Part D Notice of Creditable Coverage
2. Health Net Seniority Plus Enrollment Form
3. Health Net Seniority Plus Disenrollment Form
4. Kaiser Senior Advantage Enrollment Form California
5. Kaiser Senior Advantage Enrollment Form Hawaii
6. Kaiser Senior Advantage Enrollment Form NorthWest
7. Kaiser Senior Advantage Disenrollment Form California
8. Kaiser Senior Advantage Disenrollment Form Hawaii
9. Kaiser Senior Advantage Disenrollment Form NorthWest
10. SilverScript Employer Prescription Drugs Provider Medicare Part D Plan
 
 
1. 2020 CVS/CareMark Summary of Benefits for Anthem Blue Cross EPO
2. 2020 CVS/CareMark Summary of Benefits for Anthem Blue Cross HMO
3. 2020 CVS/CareMark Performance Drug List for Anthem Blue Cross Plans
4. 2020 CVS/CareMark Advanced Control Speciality Formulary for Anthem Blue Cross Plans
5. 2020 Prescription Drug Plan EOC for Anthem Blue Cross EPO/PPO - SilverScript Medicare
6. 2020 Prescription Drug Plan EOC for Anthem Blue Cross HMO - SilverScript Medicare
7. 2020 Prescription Drug Plan Formulary for Anthem Blue Cross  EPO/PPO - SilverScript
8. 2020 Prescription Drug Plan Fomulary for Anthem Blue Cross HMO - SilverScript
9. 2020 Health Net Active/Retirees Under 65 Drug Formulary
10. 2020 Health Net Retiree Over 65 Drug Formulary
11. Health Net Prescription Drug
12. SilverScript Employer Prescription Drug Provider Medicare Part D Plan

 

 

1. 2020 Anthem Blue Cross EPO SBC - Actives CA Residents
2. 2020 Anthem Blue Cross EPO SBC - Actives Non CA Residents
3. 2020 Anthem Blue Cross EPO SBC - Retirees and AB528 CA Residents
4. 2020 Anthem Blue Cross EPO SBC - Retirees and AB528 Non CA Residents
5. 2020 Anthem Blue Cross Select HMO SBC - Actives
6. 2020 Anthem Blue Cross Select HMO SBC - Early Retirees
7. 2020 Anthem Medicare Preferred (PPO) Medical plan
8. 2020 Prescription Drug Plan for Anthem Blue Cross EPO - CVS
9. 2020 Prescription Drug Plan for Anthem Blue Cross HMO - CVS
10. 2020 Prescription Drug Plan for Anthem Blue Cross EPO- SilverScript Medicare
11. 2020 Prescription Drug Plan for Anthem Blue Cross HMO - SilverScript Medicare
12.  2020 HealthNet HMO SBC - Actives
13. 2020 HealthNet HMO SBC - Early Retirees
14. 2020 Kaiser HMO SBC - Actives
15. 2020 Kaiser HMO SBC - Early Retirees
16. 2020 Kaiser Hawaii HMO SBC - Early Retirees
17. 2020 Kaiser NW HMO SBC - Early Retirees
18. 2019-20 Kaiser HMO SBC - Unit F
19. 2019-20 Kaiser HMO SBC - Student Body
20. 2020 VSP
21. 2020 Delta Dental
22. 2020 United Concordia PPO Benefit Summary - Active
23. 2020 United Concordia PPO Benefit Summary - Retiree
24. 2020 Western Dental

 

  MEDICAL
1. 2019 Anthem Blue Cross EPO - Active CA
2. 2019 Anthem Blue Cross EPO - Active Non-CA
3. 2019 Anthem Blue Cross EPO - Retiree CA
4. 2019 Anthem Blue Cross EPO - Retiree Non-CA
5. 2019 Anthem Blue Cross HMO - Active
6. 2019 Anthem Blue Cross HMO - Retiree
7. 2020 Anthem Medicare Preferred (PPO) Medical Plan - Medicare Retiree
8. 2019 Health Net HMO - Active
9. 2019 Health Net HMO - Early Retiree
10. 2019 Health Net HMO - Seniority Plus
11. 2020 Kaiser HMO EOC - Active
12. 2020 Kaiser HMO EOC - Early Retiree
13. Sep 2019 - Aug 2020 Kaiser HMO EOC - Unit F
14. Oct 2019 - Sept 2020 Kaiser HMO EOC - Student Body
15. 2020 Kaiser Senior Advantage EOC - Retiree Over 65 
16. 2019 Kaiser Senior Advantage EOC - Northwest
17. 2019 Kaiser Senior Advantage EOC - Hawaii
  DENTAL
17. United Concordia Dental Actives - CA
18. United Concordia Dental - MS, MT, LA, and TX
19. 2020 Delta Dental
  VISION
21. EyeMed - Active
22. EyeMed - Retiree
23. 2020 VSP

 

1. MetLife Funeral Planning Flyer
2. Anthem Blue Cross Guest Membership Flyer
3. Kaiser Travel Coverage
4. Kaiser Travel Coverage for Medicare Members