All of our member districts and charters offer a benefits package to eligible employees. Benefits may differ by the number of hours worked, classification, and/or bargaining unit. Health benefit selections are made for new hires during the hiring process and for active employees during open enrollment or due to a qualifying event.
Open Enrollment is the only time during the year you have the opportunity to change the medical, dental, and vision plans you are currently enrolled in. Open Enrollment takes place from June 1st through August 15th each year. Changes made take effect on October 1st. If you are going to have any changes in your family in the upcoming plan year, Open Enrollment is the time to determine if your plan still meets your needs.
Open Enrollment forms are due to your district/charter school office no later than
August 14, 2020, for the 2020-21 plan year.
Enrollment Forms, Annual Notices, and Information
Anthem Enrollment Form
Kaiser Enrollment Form
HIPAA Notice of Privacy
Dependent Eligibility Requirements
Declination of Coverage-Less than FT
Declination of Coverage-Full Time
If you are an employee that would like to keep your current plan and make no changes, please complete your site-specific plan election form:
Enrollment Health Plan Election Form- (Site Specific)
If you are an employee that would like to enroll in a new plan, please complete the enrollment health plan election for your site and one of the enrollment forms below.
Insurance Carrier's Enrollment- Anthem or Kaiser enrollment form
If you are an employee that needs to change your dependents please complete the enrollment health plan election form and the membership change form below:
Membership Change form-to add/delete dependents
If you are an employee that would like to decline coverage please complete one of the declinations of coverage forms below:
Declination of Coverage- less than full time
Declination of Coverage full-time (WABE)
Below are the 2020-2021 health benefit plan descriptions (SBC's)
When you enroll in one of the above medical plans (excluding the Anthem PPO 2-Tier Anchor Bronze Plan), you are automatically enrolled in the following Vision and Dental plans.
Use the Benefit Provider Contact List and contact the carrier if you have questions about a plan’s coverage and /or benefits.