2018 Domestic Partner Information, Declaration and Enrollment Form

1. 2018 Active Benefits Information
2. Health Benefits Enrollment Form - Active Employees
3. Unit F and Unit G Benefits Overview
4. 2017 Health Benefits Enrollment Form - Half-Time Active Employees
5. Request for Change of Dependent Status - Active Employees
6. 2018 Domestic Partner Information, Declaration, and Enrollment Form
7. Change of Address Form
8. Update Your Personal Information
9. Retirement Eligibility Verification Form
10. 2018 Medical Opt-Out Cash Back Attestation Form
11. 2018 Unit F - Benefits Opt-Out Cash Back Attestation Form
12. Mid Year Plan Changes
13. Application for Retiree Health Benefits HI-22 Form

 

1. 2018 Retiree Benefit Guide
2. Request for Change of Dependent Status - Retirees
3. Application for Retiree Benefits HI-22 Form
4. Change of Address Form HBR10
5. 2018 Domestic Partner Information, Declaration, and Enrollment Form
6. Mid Year Plan Changes

 

 2017 Cobra Active Employees 2018 Cobra Active Employees
 2017 Cobra District Retirees 2018 Cobra District Retirees
 2017 Cal-Cobra 2018 Cal-Cobra
 2017 AB528 2018 AB528
 2016-17 Cobra Active Teacher Asst 2017-18 Cobra Active Teacher Asst & Unit G

 

1. Enrollment At A Glance Flyer
2. Enrollment Form 
3. Request for Beneficiary Change Form
4. Request for Coverage Change Form
5. Retiree Enrollment At A Glance Flyer
6. Voya Plan Guide

 

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. 2018 FSA Newsletter
2. FSA Enrollment Form
3. FSA Request for Change Form
4. FSA Reimbursement Claim Instructions
5. Online Claim Submission Guide
6. Health Care FSA Claim Form
7. Dependent Care FSA Claim Form

 

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
8. UHC Enrollment Form Arizona 2017
9. UHC Enrollment Form California 2017
10. UHC Enrollment Form Colorado 2017
11. UHC Enrollment Form Nevada 2017
12. UHC Enrollment Form Oregon 2017
13. UHC Enrollment Form Texas 2017
14. UHC Enrollment Form Washington 2017
15. UHC Disenrollment Form 2018
16. SilverScript Employer Prescription Drugs Provider Medicare Part D Plan
 
 
1. 2017 CVS/CareMark Summary of Benefits for Anthem Blue Cross EPO
2. 2017 CVS/CareMark Summary of Benefits for Anthem Blue Cross HMO
3. CVS/CareMark Performance Drug List for Anthem Blue Cross Plans
4. CVS/CareMark Advanced Control Speciality Formulary for Anthem Blue Cross Plans
5. 2018 Prescription Drug Plan EOC for Anthem Blue Cross EPO - SilverScript Medicare
6. 2018 Prescription Drug Plan EOC for Anthem Blue Cross HMO - SilverScript Medicare
7. 2018 Prescription Drug Plan Formulary for Anthem Blue Cross  EPO - SilverScript
8. 2018 Prescription Drug Plan Fomulary for Anthem Blue Cross HMO - SilverScript
9. Health Net Active/Retirees Under 65 Drug Formulary
10. Health Net Retiree Over 65 Drug Formulary
11. Health Net Prescription Drug
12. 2017 UHC Comprehensive Drug Formulary
13. 2017 UHC Abridged Drug Formulary
14. SilverScript Employer Prescription Drug Provider Medicare Part D Plan

 

1. 2018 Prescription Drug Plan for Anthem Blue Cross EPO- SilverScript Medicare
2. 2018 Prescription Drug Plan for Anthem Blue Cross HMO - SilverScript Medicare
3. 2018 Prescription Drug Plan for Anthem Blue Cross EPO - CVS
4.  2018 Prescription Drug Plan for Anthem Blue Cross HMO - CVS
5.  2018 HealthNet HMO SBC - Actives
6.  2018 HealthNet HMO SBC - Early Retirees
7.  2018 Anthem Blue Cross EPO SBC - Actives CA Residents
8.  2018 Anthem Blue Cross EPO SBC - Actives Non CA Residents
9.  2018 Anthem Blue Cross EPO SBC - Retirees and AB528 CA Residents
10.  2018 Anthem Blue Cross EPO SBC - Retirees and AB528 Non CA Residents
11.  2018 Anthem Blue Cross Select HMO SBC - Actives
12. 2018 Anthem Blue Cross Select HMO SBC - Early Retirees
13. 2018 Kaiser HMO SBC - Actives
14. Sept 2017 - Aug 2018 Kaiser HMO SBC - Unit F and G
15.  2018 Kaiser HMO SBC - Early Retirees
16. 2018 Kaiser Senior Advantage HMO SBC - Hawaii
17. 2018 Kaiser Senior Advantage HMO SBC - Northwest
18. 2018 UHC SBC - Arizona
19. 2018 UHC SBC - California
20. 2018 UHC SBC - Colorado
21. 2018 UHC SBC - Neveda
22. 2018 UHC SBC - Oregon
23. 2018 UHC SBC - Texas
24. 2018 UHC SBC - Washington
25. 2018 United Concordia PPO Benefit Summary - Active
26. 2018 United Concordia PPO Benefit Summary - Retiree

 

1. 2018 Anthem Blue Cross EPO - Active CA
2. 2018 Anthem Blue Cross EPO - Active Non-CA
3. 2018 Anthem Blue Cross EPO - Retiree CA
4. 2018 Anthem Blue Cross EPO - Retiree Non-CA
5. 2018 Anthem Blue Cross HMO - Active
6. 2018 Anthem Blue Cross HMO - Retiree
7. 2018 Health Net HMO - Active
8. 2018 Health Net HMO - Early Retiree
9. 2018 Health Net HMO - Senority Plus
10. 2018 Kaiser HMO EOC - Active
11. 2018 Kaiser HMO EOC - Early Retiree
12. Oct 2014 - Sept 2015 Kaiser HMO EOC - Student Body
13. 2018 Kaiser Senior Advantage EOC - Retiree Over 65 
14. 2016 Kaiser Senior Advantage EOC - Northwest
15. 2016 Kaiser Senior Advantage EOC - Hawaii
16. UHC EOC Arizona 2018
17. UHC EOC California 2018
18. UHC EOC Colorado 2018
19. UHC EOC Nevada 2018
20. UHC EOC Oregon 2018
21. UHC EOC Texas 2018
22. UHC EOC Washington 2018
23. 2017 United Concordia Dental - CA
24. 2017 United Concorida Dental - MS, MT, LA, and TX
25. Western Dental
26. EyeMed - Active
27. EyeMed - Retiree
28. VSP

 

1. Voya Funeral Planning Flyer
2. Voya Security When You Travel Flyer
3. Anthem Blue Cross Guest Member Brochure
4. Anthem Blue Cross Guest Membership Flyer
5. Kaiser Travel Coverage
6. Kaiser Travel Coverage for Medicare Members