Human Resources: Where your personal and professional lives meet
ANTHEM & KAISER MANDATORY ENROLLMENT PERIOD MARCH 6, 2018 THRU APRIL 16, 2018
As a result of the District joining the Self Insured Schools of California (SISC) to purchase our medical plans as of July 1, 2018, all employees are REQUIRED to complete and submit new enrollment forms and provide documentation proving your spouse, domestic partner, and/or child's eligibiIity to be enrolled.
To help you better understand the minimal changes to copays and coverages, as well as assist you with completing the forms, SISC and Human Resources we will be holding a series of presentations throughout the District between March 6, 2018 and April 16, 2018. Please come to the time most convenient for you. In addition, Human Resources staff will be on campus throughout the enrollment period so you can conveniently drop the forms off to them.
To better prepare for this enrollment period, please see the documents below for information and be sure to check back to this website often for enrollment packets for each plan. If you are unable to print and would like to request a hard copy, please email HR.Benefits@sjeccd.edu and request a packet to be mailed to your home or campus.
Required Documents to Continue Spouse/Domestic Partner/Child(ren)
Calendar of SISC Presentations (Revised)
Anthem Blue Cross (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)
Active Employee's Plan Summary including Prescription Coverage (Anthem Blue Cross)
Active Employee's Enrollment Guidebook (Anthem Blue Cross)
Kaiser Permanente (for ALL benefit eligible active employees including eligible part-time faculty)
Active Employee's Plan Summary including Chiropractic Coverage (Kaiser)Active Employee's Enrollment Guidebook (Kaiser)
Active Employee's Plan Summary including Chiropractic Coverage (Kaiser)
Active Employee's Enrollment Guidebook (Kaiser)
Anthem Blue Cross (All Retirees regardless of age/Medicare enrollment)
Retiree Plan Summary (For all Anthem Blue Cross Covered Retirees eff 7/1/2018)
Kaiser Permanente (Retirees and Surviving Spouses <65)
Retiree Plan Summary (for Kaiser Covered Retirees, Spouses and Surviving Spouses <65)
Kaiser Permanente (Senior Advantage Plan, >65 w/Medicare Parts A&B)
Retiree Plan Summary (for Kaiser Covered Retirees, Spouses and Surviving Spouses w/Medicare)Kaiser Senior Advantage Enrollment Form (for All Kaiser Enrollees >65)
Retiree Plan Summary (for Kaiser Covered Retirees, Spouses and Surviving Spouses w/Medicare)
Kaiser Senior Advantage Enrollment Form (for All Kaiser Enrollees >65)
Click here for the list of documents you are required to submit to enroll or continue your spouse/domestic partner and/or child(ren) as of July 1, 2018.
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.
Summary of Benefits and Forms (For New Employees)
Adding an eligible dependent that is not currently covered under your medical, dental and/or vision plan requires a completed original enrollment form and:
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 eligible to decline enrollment for themselves, or any employee declining coverage for a dependent (including your spouse) because of other health insurance or group health plan coverage, 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). However, you must request enrollment within 30 days after your or your dependents' other coverage ends (or after the employer stops contributing toward the other coverage).
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 19th birthday and each birth month after that until they turn 25, adult children must be a full-time student at an accredited institution to remain covered by the District's dental, vision and EAP plan (age 21-23 for life insurance). 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 dental, vision, EAP (and possibly life insurance) coverage will be cancelled and they will be offered continuation coverage through COBRA.
Student Certification Form
If you have an adult child who is disabled, temporarily or permanentely, please contact the Benefits staff in Human Resources at extension 6713 to discuss available options of keeping him/her covered as your dependent regardless of age and/or student status.
carrier forms & flyers
Kaiser Plan Summary for Part-Time Employees Including Adjunct Faculty
Kaiser Plan Summary for Regular Employees
Kaiser Permanente Enrollment/Change Form
Kaiser Out of Area Limitations/Exclusions
Plan Summary for Early Retirees (<65)
Plan Summary for Senior Advantage (>65, enrolled in Medicare Parts A&B)
Plan Summary for Early Retirees (<65)
Plan Summary for Senior Advantage (>65, enrolled in Medicare Parts A&B)
Anthem Blue Cross Enrollment Kit (including SBC)
Anthem Blue Cross Plan Summary for Regular Employees
Anthem Blue Cross Prescription (Rx) Plan Summary
Anthem Blue Cross Prescription Home Delivery Form (Mail Order)
Anthem Blue Cross Prescription Home Delivery Flyer (Mail Order)
Anthem Blue Cross Member Claim Form (for Medical Expenses)
Anthem Blue Cross Prescription Claim Form
Anthem Blue Cross Enrollment/Change Form
Summary of Benefits for Early Retirees (<65) and those >65 with Medicare in California (1814PC & 1814PH)
Summary of Benefits for Early Retirees (<65) Out-of-State (1814PM)
Summary of Benefits for Retirees >65 with Medicare Out-of-State (1814PL)
Delta Dental Benefit Highlights
Delta Dental PPO Incentive Information
Delta Dental Provider Search Information
Delta Dental Claim Form
Delta Dental Enrollment/Change Form
VSP Summary of Benefits
Exclusive VSP Member Rebates & Special Offers
VSP Out-of-Network Claim Form
VSP Enrollment/Change Form
Legal Services Information
Financial Planning Services
Medical Care Reimbursement Account Overview Flyer
Dependent Care Reimbursement Account Overview Flyer
Qualified Transportation & Parking Fringe Benefit Plans Overview Flyer
Enrollment Form (All Flex Plans)
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, puchasing 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
Blue Cross Prescription Claim Form
iGOE Flexible Benefit Plan Reimbursement Request Form
not available for medical plans tied to Medicare
(Vision Plan effective 7/1/2013)
(EAP Plan effective 7/1/2013)
Company Code: sjeccd
800- 633-8818, Opt# 1
The TDS Group
The Variable Annuity Life Insurance Company
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