Human Resources: Where your personal and professional lives meet
If you have a plan in 2018 there is NO automatic re-enrollment, so if you do not wish to have an account in 2019, there is nothing you need to do as your paln will automatically expire at midnight, December 31, 2018. If you want an account, you MUST complete a new enrollment form. ENROLLMENT FORMS SUBMITTED TO HR PRIOR TO THIS ENROLLMENT PERIOD WILL BE RETURNED TO THE SENDER AS THE 2019 FORM MUST BE USED.
Medical Care Reimbursement Account
You can use the medical flexible spending account to cover out of pocket expenses such as co-pays for office visits, prescriptions, and deductibles, along with many other medical expenses not covered by your medical, dental, and/or vision plan(s). New participants will receive a Flexible Benefits Card automatically for your purchasing convenience. Cards are good for three years. Expired cards will automatically be replaced.
Medical Care Reimbursement Account Flyer
This plan allows you to accumulate pre-tax dollars to reimburse yourself for childcare expenses, and/or day care expenses for a disabled dependent while you are employed. Among the eligible expenses are after-school care or extended day programs, babysitters, elder care expenses (if elder is your dependent), preschool and summer day camp.
Dependent Care Reimbursement Account Flyer
This plan allows you to set pre-taxed dollars aside reimbursement of certain transportation expenses incurred as a direct result of your employment. If you take public transportation (CalTrain, Bart, VTA, etc.).
Transportation Account Flyer
For more information about Flexible Spending Accounts including forms for additional cards, automatic deposit, and the Orthodontia Treatment Statement are available by scrolling down on this page to the Flexible Spending Account section.
Full-time Faculty, CSEA Employee's eligible for Benefits and MSC Employees click here for the Enrollment Form
Adjunct Faculty click here for the correct Enrollment Form
For more information about Flexible Spending Accounts including forms for additional cards, automatic deposit, information on the automatic carry-over for medical plans and the Orthodontia Treatment Statement are available by scrolling down on this page to the Flexible Spending Account section.
Phone numbers and websites of all carriers is available by scrolling all the way to the bottom of this page. A printable list is available by clicking here.
For those of you eligible for health and welfare benefits, please review this brief summary of all the benefit plans (including optional benefits) available to you. Enrollment forms for our medical plans (chose one), dental, and vision plans are also included. Details on each plan can be found by scrolling down this page and will be discussed during your New Employee Orientation.
Brief Summary of All Health & Welfare Benefits
BENEFIT pLANS for active employees
Announcing SISC - Click here for information on why the District made this change as of July 1, 2018.
Anthem Blue Cross (Enrollment Packet for ALL benefit eligible Active employees)
Active Employee's Plan Summary including Prescription Coverage (Anthem Blue Cross)Active Employee's Enrollment Guidebook (Anthem Blue Cross)Costco Mail Order Prescription Form (Anthem Blue Cross Enrollees Only)Anthem Mobile App InstructionsAnthem Hip, Knee & Spine Surgeries (Blue Distinction REQUIREMENTS)SISC III Enrollment Form (Anthem Blue Cross)SISC III Membership Change Form (to add/terminate dependents, update address/name)Anthem In-Network Labs (SISC)Anthem Active & Fit (for all Active Employees)
Active Employee's Plan Summary including Prescription Coverage (Anthem Blue Cross)
Active Employee's Enrollment Guidebook (Anthem Blue Cross)
Costco Mail Order Prescription Form (Anthem Blue Cross Enrollees Only)
Anthem Mobile App Instructions
Anthem Hip, Knee & Spine Surgeries (Blue Distinction REQUIREMENTS)
SISC III Enrollment Form (Anthem Blue Cross)
SISC III Membership Change Form (to add/terminate dependents, update address/name)
Anthem In-Network Labs (SISC)
Anthem Active & Fit (for all Active Employees)
Kaiser Permanente (Enrollment Packet for ALL benefit eligible employees including Adjunct Faculty)
Active Employee's Plan Summary (Kaiser)Kaiser Active Plan Summary (Spanish)Active Employee's Enrollment Guidebook (Kaiser)Chiropractic & Acupuncture Benefits (NEW)
Active Employee's Plan Summary (Kaiser)
Kaiser Active Plan Summary (Spanish)
Active Employee's Enrollment Guidebook (Kaiser)
Chiropractic & Acupuncture Benefits (NEW)
Beginning October 1st, the $2,500 annual cap for services is lifted. As long as you continue to treat with a Delta PPO provider, you will have no annual cap (so if you are unlucky enough to need three crowns in one year, you may not have any out of pocket expenses). Also, if you or a covered dependent needs braces, orthodontia is now covered at 100% up to a lifetime maximum of $3,000. Bridges and dentures however are now only covered at 50% (was 70%). Below is a plan summary as well as a comparison chart comparing our old plan with our new plan.
Delta Dental Plan Summary (eff 10/01/2018)
Old Delta Dental Plan vs. New Plan Comparison Chart
Beginning October 1st, the frame allowance is increasing, examinations are available every 12 months, and the allowance for contact lenses is increasing.
VSP Plan Summary (effective 10/01/2018)
Old VSP Plan vs. New VSP Plan Comparison Chart
VSP TruHearing Hearing Aid Discount Program
AnthemEAP plans offer confidential counseling services to all our benefit eligible employees and covered retirees, their dependents and anyone living in the employee/covered retiree's household. Telephonic, electronic (like Facetime or Skype), and in person counseling services are available, as are legal services, financial planning services, child care assistance, elder care assistance, discounted tickets for movies and attractions, etc., as are resources for tobacco, alcohol and drug dependency and our over all emotional health and mental wellness.
Old EAP (MHN) vs New EAP (Anthem) Comparison Chart
Legal & Financial Services
Child Care Resources
Elder Care Resources
myStrength Emotional Health & Wellness
EAP Savings Center (discount tickets)
Substance Abuse Resources
Dependent Eligibility Chart
Anthem Blue Cross -
Retiree Plan Summary (For all Covered Retirees eff 7/1/2018)EAP Plan (See EAP section above for more information on benefits/services available)
Retiree Plan Summary (For all Covered Retirees eff 7/1/2018)
EAP Plan (See EAP section above for more information on benefits/services available)
Kaiser Permanente -
Early Retiree Plan Summary (<65)EAP Plan (information for those <65)Senior Advantage Plan Summary (Retirees 65+)Kaiser Senior Advantage Enrollment Form (for All Kaiser Enrollees >65)Silver & Fit Flyer For Kaiser Senior Advantage Enrollees OnlyAnthemEAP for Kaiser Senior Advantage Enrollees Only
Early Retiree Plan Summary (<65)
EAP Plan (information for those <65)
Senior Advantage Plan Summary (Retirees 65+)
Kaiser Senior Advantage Enrollment Form (for All Kaiser Enrollees >65)Silver & Fit Flyer For Kaiser Senior Advantage Enrollees OnlyAnthemEAP for Kaiser Senior Advantage Enrollees Only
Kaiser Senior Advantage Enrollment Form (for All Kaiser Enrollees >65)
Silver & Fit Flyer For Kaiser Senior Advantage Enrollees OnlyAnthemEAP for Kaiser Senior Advantage Enrollees Only
Silver & Fit Flyer For Kaiser Senior Advantage Enrollees Only
AnthemEAP for Kaiser Senior Advantage Enrollees Only
To change your address, name, add/remove a dependent please print, complete, sign and return the form below to HR.Benefits@sjeccd.edu, fax to 408.239.8804, or mail it via the Pony or US Mail to
Michelle McKay, Human Resources, 40 South Market Street San Jose, CA 95113.
SISC III Member Change Form
Adding an eligible dependent that is not currently covered under your medical, dental and/or vision plan requires a completed original enrollment form and:
YOU MUST ENROLL YOUR NEW DEPENDENT(S) WITHIN 30 DAYS OF THE EVENT (birth, marriage, adoption, etc.) or you may not be able to enroll them until the next regular Open Enrollment Period.
As a reminder, it is the employee’s responsibility to notify the Benefits Coordinator in Human Resources within 60 days of the event if you have a covered dependent that ceases to be your dependent; for example:
Failure to timely notify the District (by emailing the Benefits Coordinator in Human Resources) will result in loss of continuation coverage rights under COBRA and may include the carrier(s) billing you for services the ineligible dependent received and/or reimbursement of District paid premiums.
For specific eligibility questions contact the HR Benefits Office at extension 6713 or
Health Insurance Portability & Accountability Act (HIPAA): For those who have declined enrollment for themselves, or any employee who elected to not enroll an eligible dependent (spouse, child, domestic partner) because of enrollment in another health insurance plan, you may be able to enroll yourself and your dependents in a District plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents' other coverage) IF you request enrollment within 30 days after your or your dependents' other coverage ends (or after the employer stops contributing toward the other coverage). Failure to notify the Benefits Coordinator timely means you will have to wait until the next regular open enrollment period.
In addition, if you have a new dependent as a result of marriage, birth, adoption or placement for adoption, you may be able to enroll yourself and your dependents. However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption.
To request special enrollment or obtain more information, contact Michelle McKay, Benefits Coordinator at 408.223.6713 or HR.Benefits@sjeccd.edu.
Beginning on their 21st birthday and each birth month after that until they turn 23, adult children must be a full-time student at an accredited institution to remain covered by the District's life insurance policy. Before the last day of their birth month, a copy of their current class schedule indicating their total units, or a letter from the school stating their full-time status, and the form below must be submitted to the Human Resources Department or their life insurance coverage will end.
Student Certification Form
If you have an adult child who is disabled, temporarily or permanently, please contact the Benefits staff in Human Resources at extension 6713 to discuss available options of keeping him/her covered UNDER ALL PLANS regardless of age and/or student status. Adult children who become disabled after age 26 and become dependent on you may be eligible for enrollment under the District's health and welfare plans. Please contact HR.Benefits@sjeccd.edu or call 408.223.6713 immediately for more information and required documentation.
Please note: due to the number of District employees, we are unable to verify the current emergency contact and/or the beneficiary(s) you have on file. If any time during the year you are unsure of who/what you listed, complete a new form(s) and submit the original(s) to Human Resources. All forms above are available all year long on this page and the Human Resources page.
Medical Care Reimbursement Account Overview Flyer
Dependent Care Reimbursement Account Overview Flyer
Qualified Transportation & Parking Fringe Benefit Plans Overview Flyer
Medical Care Reimbursement Account Carry Over FAQ
2017 Plan Highlights
iGOE Orthodontia Treatment Statement
Form for Additional Card (for spouse)
iGOE Direct Deposit Form
Dependent Day Care Provider Acknowledgement
Setting up your Website and iGOE App Account
FSA Carryover Employee Fact Sheet
Optional Forms (see below):
retirement accounts (403B & 457 plans)
Please refer to Payroll's Public Folder in Outlook for the required forms to enroll in or make changes to a 457 Deferred Compensation Account and for inquires to 403b accounts.
All permanent employees, full and part-time, and adjunct faculty are eligible to enroll in either plan. It does not matter whether you are currently a member of PERS or STRS. It also does not matter what union or constituency group to which you belong.
General 457 Retirement Plan information including annual limits and catch up information
How to enroll in the TIAA-CREF 457 Plan
CalPERS 457 Plan (website)
Click here for Valic Contact Information
pension plans: calpers & calstrs
PERS Address Change Form (Complete and Mail to PERS)
PERS Beneficiary Designation Form
STRS Address Change Form (Complete and Mail to STRS)
STRS Forms including Beneficiary Designation
Academic Managers & Full-Time Faculty
Classified Managers, Supervisors & Confidential Employees
- CSEA Unit Members
Basic Life Insurance & Accidental Death and Dismemberment (All)
Hartford Beneficiary Form
Supplemental Life Insurance Brochure (Please contact
HR.Benefits@sjeccd.edu to request an enrollment form)
Personal Health Application
Estate Planning Assistance
Travel Assistance Program
Addition Benefits/Resources from Hartford
To view the PowerPoint presentation on beneficiary designations, purchasing additional life insurance to and other benefits/services The Hartford provides eligible employees (from presentations held onsite April 14, 2015) please click the link below:
Supplemental Life Insurance Workshop, April 2015
VSP Out-of-Network Claim Form
iGOE Flexible Benefit Plan Reimbursement Request Form
Kaiser Plan Summary for Part-Time Employees Including Adjunct Faculty (thru June 30, 2018)
Kaiser Plan Summary for Regular Employees (thru June 30, 2018)
Kaiser Permanente Enrollment/Change Form
Kaiser Out of Area Limitations/Exclusions
Plan Summary for Early Retirees (<65) (thru June 30, 2018)Plan Summary for Senior Advantage (>65, enrolled in Medicare Parts A&B) (thru June 30, 2018)
Plan Summary for Early Retirees (<65) (thru June 30, 2018)
Plan Summary for Senior Advantage (>65, enrolled in Medicare Parts A&B) (thru June 30, 2018)
Anthem Blue Cross Enrollment Kit (including SBC) (thru June 30, 2018)
Anthem Blue Cross Plan Summary for Regular Employees (thru June 30, 2018)
Anthem Blue Cross Prescription (Rx) Plan Summary (thru June 30, 2018)
Anthem Blue Cross Prescription Home Delivery Form (Mail Order) (thru June 30, 2018)
Anthem Blue Cross Prescription Home Delivery Flyer (Mail Order) (thru June 30, 2018)
Anthem Blue Cross Member Claim Form (for Medical Expenses) (thru June 30, 2018)
Anthem Blue Cross Prescription Claim Form (thru June 30, 2018)
Anthem Blue Cross Enrollment/Change Form (thru June 30, 2018)
Summary of Benefits for Early Retirees (<65) and those >65 with Medicare in California (1814PC & 1814PH) (thru June 30, 2018)
Summary of Benefits for Early Retirees (<65) Out-of-State (1814PM) (thru June 30, 2018)
Summary of Benefits for Retirees >65 with Medicare Out-of-State (1814PL) (thru June 30, 2018)
not available for medical plans tied to Medicare
SISC - Anthem Blue Cross
1-800-322-5709 (See # on ID Card)
SISC - Kaiser
Chiropractic & Acupuncture Benefits (ASH Network)
1-800-678-9133 (TTY 711)
SISC - VSP
SISC - EAP
"SJECCD" (for Kaiser Senior Advantage Enrollees only)
"SISC" (for everyone else)
Member ID: Your SSN
Employer ID: IGOSJCC
800- 633-8818, Opt# 1
The TDS Group
If you are an employee currently enrolled in the District's Kaiser Permanente or Anthem Blue Cross Plan and you are nearing your 65th birthday, please see the pamphlet below provided by Medicare to learn about the steps you should take to enroll in Medicare Parts A&B (and possibly D) and when.
The District recommends you (and/or your spouse) enroll in Part A upon turning 65 - it's free - but you are not required to enroll in Medicare Part B (or D) in order to continue your medical coverage as an active employee with SJECCD. However, if you have other medical coverage you should reach out to that employer to assure compliance with their plan(s).
The District's plan will remain your primary while actively employed, therefore, we do not require you to sign up and pay for Part B (or D) upon your 65th birthday. You should take steps with Medicare to assure Parts B & D (and A if not already enrolled) are effective the first of the month after your employment/coverage ends with SJECCD.
Click here for the 2017 Creditable Coverage Notice (mailed September 2017)
Please see the Medicare Brochures below:
Applying Online for Medicare - Even if you Are Not Ready to Retire 2017
Medicare and You 2017