Benefits

​​​​​Benefits

 Human Resources: Where your personal and professional lives meet

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)

 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

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 Supplemental Income Plans Website

 

Valic:

Click here for Valic Contact Information

 

Pension Plans: 

PERS:

PERS Address Change Form (Complete and Mail to PERS)

PERS Website

PERS Beneficiary Designation Form

 

STRS:

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 HR.Benefits@sjeccd.edu 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 Crosswww.anthem.com 1-800-365-0020
Kaiserwww.kp.org 1-800-464-4000
Delta Dentalwww.deltadentalins.com 1-800-765-6003

VSP Choice

(Vision Plan eff 7/1/2013)

www.vsp.com1-800-877-7195

MHN

(EAP Plan eff 7/1/2013)

http://members.mhn.com

Company Code: sjeccd

1-800-227-1060
CAL PERS 457 Planhttp://www.calpers.ca.gov/index.jsp?bc=/member/def-comp-supp/457/home.xml 1-800-260-0659
Hartford Life & LTDwww.thehartford.com 1-800-572-9047
IGOE-Flexible Spending Accountwww.goigoe.com

800- 633-8818, Opt# 1

PERSwww.calpers.ca.gov 1-888-225-7377
STRSwww.calstrs.com 1-800-228-5453

The TDS Group

(403b Administrators)

www.tdsgroup.org

 

1-866- 446-1072, Option #4
TIAA-CREFF (457 plan)www.tiaa-cref.org

1-800-842-2252

VALIC

The Variable Annuity Life Insurance Company

www.valic.com

408-529-8846

Geoffrey Akers

SJECCD Supporting Page
District
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