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. 2019 Health Benefits Enrollment Form - Half-Time Active Employees
6. Request for Change of Dependent Status - Active Employees
7. 2019 Domestic Partner Information, Declaration, and Enrollment Form
8. Change of Address Form
9. Update Your Personal Information
10. Retirement Eligibility Verification Form
11. 2019 Medical Opt-Out Cash Back Attestation Form
12. 2019-20 Unit F - Benefits Opt-Out Cash Back Attestation Form
13. Mid Year Plan Changes
14. 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. 2019 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. FSA Enrollment Form
4. FSA Request for Change Form
5. Health Care FSA - How to Submit a Claim Instructions
6. Dependent Care FSA - How to Submit a Claim Instructions
7. ConnectYourCare Mobile
8. 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. 2019 CVS/CareMark Summary of Benefits for Anthem Blue Cross EPO
2. 2019 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. 2019 Prescription Drug Plan EOC for Anthem Blue Cross EPO/PPO - SilverScript Medicare
6. 2019 Prescription Drug Plan EOC for Anthem Blue Cross HMO - SilverScript Medicare
7. 2019 Prescription Drug Plan Formulary for Anthem Blue Cross  EPO/PPO - SilverScript
8. 2019 Prescription Drug Plan Fomulary for Anthem Blue Cross HMO - SilverScript
9. 2019 Health Net Active/Retirees Under 65 Drug Formulary
10. 2019 Health Net Retiree Over 65 Drug Formulary
11. Health Net Prescription Drug
12. SilverScript Employer Prescription Drug Provider Medicare Part D Plan

 

1. 2019 Prescription Drug Plan for Anthem Blue Cross EPO- SilverScript Medicare
2. 2019 Prescription Drug Plan for Anthem Blue Cross HMO - SilverScript Medicare
3. 2019 Prescription Drug Plan for Anthem Blue Cross EPO - CVS
4.  2019 Prescription Drug Plan for Anthem Blue Cross HMO - CVS
5.  2019 HealthNet HMO SBC - Actives
6.  2019 HealthNet HMO SBC - Early Retirees
7.  2019 Anthem Blue Cross EPO SBC - Actives CA Residents
8.  2019 Anthem Blue Cross EPO SBC - Actives Non CA Residents
9.  2019 Anthem Blue Cross EPO SBC - Retirees and AB528 CA Residents
10.  2019 Anthem Blue Cross EPO SBC - Retirees and AB528 Non CA Residents
11.  2019 Anthem Blue Cross Select HMO SBC - Actives
12. 2019 Anthem Blue Cross Select HMO SBC - Early Retirees
13. 2019 Anthem Medicare Preferred (PPO) Medical plan
14. 2019 Kaiser HMO SBC - Actives
15.  2019 Kaiser HMO SBC - Early Retirees
16. 2018 Kaiser Senior Advantage HMO SBC - Hawaii
17. 2019 Kaiser Senior Advantage HMO SBC - Northwest
18. 2019 Kaiser HMO SBC - Unit F
19. 2019 Kaiser HMO SBC - Unit G
20. 2019 United Concordia PPO Benefit Summary - Active
21. 2019 United Concordia PPO Benefit Summary - Retiree

 

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. 2019 Anthem Medicare Preferred (PPO) Medical Plan - Medicare Retiree
8. 2018 Health Net HMO - Active
9. 2018 Health Net HMO - Early Retiree
10. 2018 Health Net HMO - Seniority Plus
11. 2019 Kaiser HMO EOC - Active
12. 2019 Kaiser HMO EOC - Early Retiree
13. Oct 2018 - Sept 2019 Kaiser HMO EOC - Student Body
14. 2019 Kaiser Senior Advantage EOC - Retiree Over 65 
15. 2018 Kaiser Senior Advantage EOC - Northwest
16. 2018 Kaiser Senior Advantage EOC - Hawaii
17. United Concordia Dental - CA
18. United Concordia Dental - MS, MT, LA, and TX
19. Delta Dental
20. Western Dental
21. EyeMed - Active
22. EyeMed - Retiree
23. 2019 VSP

 

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