The annual Open Enrollment period – which begins May 23 and ends June 8, 2018 – is an opportunity to review your benefits to ensure the best plan for you and your family.
If you want to make changes to your medical, dental, or vision plans, please complete the enrollment form, any required documentation, and return it to the Payroll/Benefits Office by June 8. You do not need to do anything if you plan to keep your current plans. However, if you are currently enrolled in a Section 125 Plan, you will need to re-enroll to continue (see Section 125 Plan Information below).
Forms for Active Employees*:
2019 Insurance Rate Sheet
Kaiser HMO Enrollment Form
Kaiser HSA Enrollment Form
Anthem HMO/PPO Enrollment Form
Anthem HSA Enrollment Form
Dental and Vision Buy Up Form (all employees are automatically enrolled in Dental and Vision - this is for an enhanced plan)
Pre-Tax Authorization Form
Links to Plan Benefit Summaries:
HMO PPO Summary of Benefits
HSA Summary of Benefits
Kaiser Traditional Plan Benefit Summary
Kaiser HSA Plan Benefit Summary
Anthem PPO 90-20 Plan Benefit Summary
Anthem PPO 80-20 Plan Benefit Summary
Anthem HMO Plan Benefit Summary
Delta Dental Base Plan Benefit Summary
Delta Dental Enhanced Plan Summary
Vision (VSP) Base Plan
Vision Enhanced Plan Summary
Anthem HMO East Bay Provider Directory
Dependent Eligibility Chart
* Includes retirees on the "5-Year Bridge Program"
Section 125 Plan Information:
American Fidelity administers the flex spending and health savings accounts. If you wish to enroll or re-enroll in a Section 125 plan, you must sign up with American Fidelity. Representatives will be available at the District Office June 4 and June 7 (8:00 AM - 4:00 PM) to provide information regarding the various options. If you are unable to meet with them during that time, please contact American Fidelity at 1-800-365-8306, ext 0.