​​​ Human Resources: Where your personal and professional lives meet


As a result of the District joining the Self Insured Schools of California (SISC) to purchase our medical plans all employees and retirees 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. 





Announcing SISC - Click here for information on why the District made this change.

All of the District's current Anthem Blue Cross and Kaiser Permanente Plans END June 30, 2018.  If you did not submit a SISC enrollment form, you will not have coverage effective July 1, 2018.


SISC Enrollment Packets & Plan Information


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)

Costco Mail Order Prescription Form (Anthem Blue Cross Enrollees Only)

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)



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)


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. 


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.  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)​ Effective through June 30, 2018 only.


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 previous year's Federal Tax Return (first page, redacted financial info)
    • To add a domestic partner: a copy of your State Registration form (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
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. 

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


Waiving Coverage (for Employees & their Dependents)

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


Covering Adult Children

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 permanently, 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. 


Keep your beneficiaries up to date

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. ​​

carrier forms & flyers 

 Medical Plans

Kaiser Permanente

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

Retiree Information

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

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) 

 Retiree Information

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)


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, 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.


457 Plan Overview:

General 457 Retirement Plan information including annual limits and catch up information


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 In​surance

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


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

 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


​​​ Plan​ Website Customer Service Number
Anthem Blue Cross 1-800-365-0020
Kaiser 1-800-464-4000
Delta Dental 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 & LTD 1-800-572-9047
IGOE-Flexible Spending Account

800- 633-8818, Opt# 1

PERS 1-888-225-7377
STRS 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