​​​​​Benefits - it's open enrollment time!

 Human Resources: Where your personal and professional lives meet

October 1, 2017 through October 31, 2017​

is SJECCD's Open Enrollment Period

All Forms & Documentation are due on or before October 31, 2017

October is the month that everyone eligible for a District medical, dental and/or vision plan has the opportunity to make changes to your plan (including switching plans). This is NOT the enrollment period for 2018 Flexible Spending Accounts; that will be in December.

This does not include a Flexible Spending Account!

For example, if you are a regular employee currently enrolled in Anthem Blue Cross, and you would like to switch to Kaiser, now is the time. The same applies to those enrolled in Kaiser that would like to switch to Anthem Blue Cross. This is the only time during the year that you may voluntarily switch. Your new plan will take effect November 1, 2017. Plan summaries, enrollment forms and more information about the plans are available below by carrier. Hard copies are available by emailing

You may also add or remove dependents (spouse, domestic partner, and/or child) from your coverage during this period.

If you are currently enrolled in the District’s Health Benefit Waiver program and would now like to enroll in a medical plan, you may do so during this Open Enrollment Period or confirm your desire to continue to receive the waiver. Full-time faculty, managers, supervisors, and confidential employees with comparable coverage may switch to the Health Waiver program now too. Please contact or call 408.223.6713 for the proper forms.


Adjunct Faculty:

If you missed the September 22nd enrollment deadline for the Kaiser Plan for Adjunct Faculty and would like to enroll (or re-enroll) effective November 1, now is your chance!! A Kaiser Enrollment form (see below) and a Verification of Eligibility form are required (see below). 



Please call 408.223.6713 and speak to Claudia or Michelle or email them at for information on switching plans and/or adding or removing a dependent.  Plan information is available below.


Adding Dependents:

Adding an eligible dependent that is not currently covered under your medical, dental and/or vision plan requires a completed original enrollment form and:

    • To add a spouse: a copy of your certified marriage certificate;
    • To add a domestic partner: a copy of your State Registration form, or a completed District Affidavit (applies to same sex couples only, unless one is 62 or older);
    • To add your child (adopted, biological, or step): a copy of his/her certified birth certificate and:
    • Delta Dental and/or VSP - For those 19 - 25, a Student Certification Form and a copy of their current class schedule indicating they are a full-time student at an accredited institution.
    • Kaiser Permanente or Anthem Blue Cross – For those under age 26, the plan enrollment form

Removing Dependents:

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:

    • You get divorced. 
    • Your child between the ages of 19 – 25, gets married or is not a full time student at an accredited institution. (They can remain on Blue Cross or Kaiser, but not dental, vision, the EAP or life insurance). It is your responsibility to notify Human Resources timely.
    • Your child becomes an active member of the military.

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


Forms Due 10/31/2017:

All original enrollment forms and any required supporting documentation must be received in Human Resources by 5:00pm, Tuesday, October 31, 2017, or postmarked by the US Mail by Tuesday, October 31, 2017.

The effective date of the change will be November 1, 2017. Once your enrollment/change is processed, Member ID Cards for Kaiser and Anthem will be mailed by the carrier directly to your home in 10-14 business days. There are no ID cards for Delta and VSP.

The Flexible Spending enrollment period for 2018 accounts will be in November/December as always.



Anthem Blue Cross Enrollment/Change Form

Kaiser Permanente Enrollment/Change Form

Delta Dental Enrollment/Change Form

VSP Enrollment/Change Form


Update your information

October is also a great month to...

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.


welcome 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)


carrier forms & flyers 

 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 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  


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 permanently, 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

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, 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 457 Plan (website)



Click here for Valic Contact Information

 pension plans: calpers & calstrs


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  

 life insurance & long term disability

The Hartford:

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 effective 7/1/2013)



(EAP Plan effective 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


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

SJECCD Supporting Page