Human Resources: Where your personal and professional lives meet

Spring '17 Kaiser & Flexible Spending Account

 Enrollment Period for Adjunct Faculty

February 13, 2017 through February 27, 2017 (Only)

To All Adjunct Faculty:

On behalf of the Human Resources Department, Welcome to Spring Semester 2017!

The District is pleased to offer a medical plan for adjunct faculty who qualify.  Enrollment for the plan, offered through Kaier Permanente, is available each semester to employees and their eligible dependnets.  If enrolled this semester, coverage will be in effect March 1, 2017 through August 31, 2017 and the premium is deducted from your March, April, May and June paychecks.  You will be required to re-enroll, if eligible, each semester.

To be eligible: you must carry at least a 40% cumulative equivalent load (of a full-time faculty assignment) on February24, 2017; you may not have any other medical coverage; you must pay at least 50% of the premium (100% for any eligible covered dependents).


To enroll, you must sign up between February 13 and February 27th.  The Kaiser Enrollment Form, the Verification of Eligiblity, and proof of dependent eligiblity (if applicable) are all that is required (see below).  ALL DOCUMENTS MUST BE SUBMITTED TO HUMAN RESOURCES BY 5PM MONDAY FEBRUARY 27, 2017.  NO LATE FORMS WILL BE ACCEPTED.

The monthly premium (through June 30, 2017) is $673.12 employee only, $1,346.24 employee plus spouse/domestic partner, $1,211.61 employee plus child/children, and $2,086.67 for family coverage.  The District will contribute $336.56 toward the above.  Deducted from your March, April, May and June paychecks will be $504.84/employee only; $1,514.52/employee + spouse/DP; $1,312.58/employee + child/ren; $2,625.17/family.

For more information, please select the links below:


Kaiser Plan Summary for Part-Time Employees Including Adjunct Faculty

Spring 2017 Informational Letter


To Enroll (print the following two pages, complete them and return them via the Pony to Benefits in Human Resources at the District Office, or mail them to 40 South Market Street, San Jose, CA  95113):


2017 Verification of Eligibility Form

 Kaiser Enrollment Form


Those currently enrolled from Fall 2016 must submit the "Verification of Eligibility Form" by the due date or your plan will be cancelled as of March 1, 2017.


If you did not have an assignment in the Fall you may now enroll in a Flexible Spending Account for the remainder of 2017.  Please see the information below.  This enrollment form is due February 27, 2017 also.

Flexible Spending Account Information

Flexible Spending Account Enrollment Packet

For more information, please scroll to the Flexible Spending Account section below.



For New Employees

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.  For more details on each plan, please scroll down. 

Summary of Benefits and Forms (For New Employees)

 Medical Plans

Kaiser Permanente

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


Anthem Blue Cross

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 Claim Form (Medical Expenses)

Anthem Blue Cross Prescription Claim Form

Anthem Blue Cross Enrollment/Change Form  


Student Certification Form

Beginning on their 19th birthday and each year 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 and the form below must be submitted to the Human Resources Department or their 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 for discuss available options of keeping your child covered. 


Dental Plan: (Delta Dental - PPO)

Delta Dental Benefit Highlights

Delta Dental PPO Incentive Information

Delta Dental Provider Search Information

Delta Dental Claim Form

Delta Dental Enrollment/Change Form


Vision Plan: VSP (Effective 7/1/2013)

VSP Summary of Benefits

Exclusive VSP Member Rebates & Special Offers

VSP Out-of-Network Claim Form

VSP Enrollment/Change Form


Employee Assistance Plan: (EAP) - MHN (effective 7/1/2013)

EAP Overview

Legal Services Information

Financial Planning Services


Flexible Spending Accounts:

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, 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.


 457 Plan Overview (including 2014 limits):

457 Outline (from TIAA-CREF) March '14.doc


TIAA-CREF 457 Plan:

How to enroll in the TIAA-CREF 457 Plan


CalPERS 457 Plan:

CalPERS Supplemental Income Plans Website



Click here for Valic Contact Information


Pension Plans: 


PERS Address Change Form (Complete and Mail to PERS)

PERS Website

PERS Beneficiary Designation Form



STRS Address Change Form (Complete and Mail to STRS)

STRS Website

STRS Forms including Beneficiary Designation  


The Hartford:

Long Term Disability and Life Insurance:


Long Term Disability Insurance:

    - Academic Managers & Full-Time Faculty

    - Classified Managers, Supervisors & Confidential Employees

    - CSEA Unit Members

Life Insurance

Basic Life Insurance & Accidental Death and Dismemberment (All)

Hartford Beneficiary Form

Supplemental Life Insurance Brochure (Please contact to request an enrollment form)

Personal Health Application

Estate Planning Assistance


Travel Assistance Program

Addition Benefits/Resources from Hartford


If you would like to see the presentation on life insurance shown during the workshops the week of April 14, 2015 please click the link below:

Supplemental Life Insurance Workshop, April 2015


Claim Forms:

Blue Cross Prescription Claim Form

VSP Out-of-Network Claim Form

iGOE Flexible Benefit Plan Reimbursement Request Form



Summary of Benefits and Coverage (SBC's)


Anthem Blue Cross


Kaiser Permanente


Delta Dental

Summaries are not available for medical plans tied to Medicare


PlanWebsiteCustomer Service Number
Anthem Blue 1-800-365-0020 1-800-464-4000
Delta 1-800-765-6003

VSP Choice

(Vision Plan eff 7/1/2013)



(EAP Plan eff 7/1/2013)

Company Code: sjeccd

CAL PERS 457 Plan 1-800-260-0659
Hartford Life & 1-800-572-9047
IGOE-Flexible Spending

800- 633-8818, Opt# 1 1-888-225-7377 1-800-228-5453

The TDS Group

(403b Administrators)


1-866- 446-1072, Option #4
TIAA-CREFF (457 plan)



The Variable Annuity Life Insurance Company


Geoffrey Akers

SJECCD Supporting Page