Phone numbers and websites of all carriers is available by scrolling all the way to the bottom of this page.  A printable list is available by clicking here.

2019 OPEN ENROLLMENT 08/23/2019 - 09/20/2019

As a result fo the District joining the Self-Insured Schools of California JPA (SISC) in 2018, the timeline for our regular Open Enrollment period has changed.  This does NOT change the enrollment period for Flexible Spending Accounts.  As in the past, that enrollment period will be held in November/December for 2020 Accounts.  

What is Open Enrollment:

Open Enrollment (OE) is the only time during the year that employee's and covered retirees can voluntarily swap medical plans and employees can add or remove an eligible dependent, and/or enroll in a medical, dental and/or vision plan that they are currently eligible for, but not enrolled. (Retirees are not allowed to add a new dependent to their plan.)

If I make a change, what would be the effective date:

All changes made will be effective October 1, 2019. 

What if I don't want to make any changes; I like things exactly as they are now:

Changes will only be made to your plan if you make one.  There is nothing you need to do.

I have the Health Waiver, what does this mean for me:

If you would like to cancel the waiver and enroll in a plan, simply complete the enrollment form of the plan you wish to enroll in (Anthem Blue Cross or Kaiser Permanente) and submit it along with documents proving dependent's eligibility, if applicable, to Human Resources by September 20th and you will be enrolled in the plan(s) effective October 1, 2019.  

To maintain your eligibility for the health waiver, you must provide proof of your other coverage by September 20, 2019.  A notice will be mailed to you with more information.  

Please note: the Health Waiver is only offered to employees currently enrolled in it. You may not switch from a plan to a waiver.    

How do I add or drop an eligible dependent from my current plan(s):


If you are adding an eligible dependent to your current plan(s), simply submit the SISC III Membership Change Form along with proof of your dependent's eligibility (click here for the list or acceptable documents) to Human Resources by the due date.


To drop a dependent from your plan(s) simply complete the SISC III Membership Change Form and return it to Human Resources by the due date above.  

For active employees and covered retirees  (full-time faculty, CSEA members, MSC employees, executive employees and trustees):

To SWITCH to Anthem Blue Cross from Kaiser Permanente you must print, complete, sign and submit this Anthem Blue Cross Enrollment Form to Human Resources on or before September 20, 2019. 

To SWITCH to Kaiser Permanente from Anthem Blue Cross, you must print, complete, sign and submit this Kaiser Permanente Enrollment Form to Human Resources on or before September 20, 2019

For Adjunct Faculty:

Information on the cost, monthly deduction and plan design of the Kaiser Permanente Plan adjunct faculty with at least a 40% load this semester may participate in is available on the Adjunct Faculty Page by clicking on the link along the left column of this page (under Benefits).  .  During Open Enrollment, you may enroll in the plan and if currently enrolled, you may add or drop a dependent.

Note, the regular enrollment period for this semester is September 13 through September 20.  If you sign up during this period your effective date of coverage will be September 1, 2019.  If you sign up under Open Enrollment, your effective date of coverage will be October 1, 2019.

How do I submit my form(s):

We will accept electronic versions of enrollment forms and change forms, however, they must have your actual signature on them.  Electronic signatures are not accepted.  Keep in mind, social security numbers and dates of birth are required, therefore, submitting in person, or sending a hard copy through the Pony or US Mail are the safest route.  For your convenience, your benefits staff will be on each campus during the week of September 9th to answer your questions and accept forms.  Forms and plan information are available below.

Email form(s) to: 

Fax form(s) to HR Benefits: 408.239.8804

For Retirees:


If you would like to change plans please complete the following documents for the plan you want to switch to:

To switch from Blue Cross to Kaiser (to have Kaiser as of 10/1/19):

Kaiser Permanente Enrollment Form (all retirees switching to Kaiser must complete this form)

Kaiser Permanente Senior Advantage Enrollment Packet (everyone 65 or older must complete their own Senior Advantage packet to enroll).

To switch from Kaiser to Blue Cross (to have Blue Cross as of 10/1/19)

SISC III Enrollment Form

Kaiser Permanente Disenrollment Form (for anyone over age 65)

Please scroll down for plan information.  You may also call 408.223.6713 or email for information and assistance with the forms.  If you are unable to print from home, please call to request a hard copy and we will mail one to you.  

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.

Brief Summary of All Health & Welfare Benefits


BENEFIT PLANS for active employees

Announcing SISC - Click here for information on why the District made this change as of July 1, 2018.

Medical Plans

Anthem Blue Cross (Enrollment Packet 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)

Anthem Mobile App Instructions

Anthem Hip, Knee & Spine Surgeries (Blue Distinction REQUIREMENTS)

SISC III Enrollment Form (Anthem Blue Cross)

SISC III Membership Change Form (to add/terminate dependents, update address/name)

Anthem In-Network Labs (SISC)

How to Print a Temporary ID Card (Anthem Blue Cross only)


Kaiser Permanente (Enrollment Packet for ALL benefit eligible employees including Adjunct Faculty) 

Active Employee's Plan Summary (Kaiser)

Kaiser Active Plan Summary (Spanish)

Active Employee's Enrollment Guidebook (Kaiser)

Chiropractic & Acupuncture Benefits (NEW)

Dental Plan

Beginning October 1st, the $2,500 annual cap for services is lifted.  As long as you continue to treat with a Delta PPO provider, you will have no annual cap (so if you are unlucky enough to need three crowns in one year, you may not have any out of pocket expenses).  Also, if you or a covered dependent needs braces, orthodontia is now covered at 100% up to a lifetime maximum of $3,000.  Bridges and dentures however are now only covered at 50% (was 70%).  Below is a plan summary as well as a comparison chart comparing our old plan with our new plan.  

Delta Dental Plan Summary (eff 10/01/2018)

Old Delta Dental Plan vs. New Plan Comparison Chart


Vision Plan 

Beginning October 1st, the frame allowance is increasing, examinations are available every 12 months, and the allowance for contact lenses is increasing. 

VSP Plan Summary (effective 10/01/2018)

Old VSP Plan vs. New VSP Plan Comparison Chart

VSP TruHearing Hearing Aid Discount Program


Employee Assistance Plan (EAP)

AnthemEAP plans offer confidential counseling services to all our benefit eligible employees and covered retirees, their dependents and anyone living in the employee/covered retiree's household.  Telephonic, electronic (like Facetime or Skype), and in person counseling services are available, as are legal services, financial planning services, child care assistance, elder care assistance, discounted tickets for movies and attractions, etc., as are resources for tobacco, alcohol and drug dependency and our over all emotional health and mental wellness. 

AnthemEAP Pamphlet

Old EAP (MHN) vs New EAP (Anthem) Comparison Chart

Legal & Financial Services

Child Care Resources

Elder Care Resources

myStrength Emotional Health & Wellness

EAP Savings Center (discount tickets)

Depression Resources

Substance Abuse Resources


Documents Accepted to Prove Dependent Eligibility for all plans (eff 7/1/2018) 

Dependent Eligibility Chart


benefit plans for eligible retirees

Anthem Blue Cross -  

Retiree Plan Summary (For all Covered Retirees eff 7/1/2018)

EAP Plan (See EAP section above for more information on benefits/services available)


Kaiser Permanente -

Early Retiree Plan Summary (<65)

EAP Plan (information for those <65)

Senior Advantage Plan Summary (Retirees 65+)

Kaiser Senior Advantage Enrollment Form (for All Kaiser Enrollees >65)

Silver & Fit Flyer For Kaiser Senior Advantage Enrollees Only

AnthemEAP for Kaiser Senior Advantage Enrollees Only


Address, Name, and Dependent Changes:

To change your address, name, add/remove a dependent please print, complete, sign and return the form below to, fax to 408.239.8804, or mail it via the Pony or US Mail to

Michelle McKay, Human Resources, 40 South Market Street San Jose, CA  95113.

SISC III Member Change Form


 Adding/Removing Dependents

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:
      • For all plans: SISC III Member Change 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 or dependents)

Health Insurance Portability & Accountability Act (HIPAA): For those who have declined enrollment for themselves, or any employee who elected to not enroll an eligible dependent (spouse, child, domestic partner) because of enrollment in another health insurance plan, 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) IF you request enrollment within 30 days after your or your dependents' other coverage ends (or after the employer stops contributing toward the other coverage).  Failure to notify the Benefits Coordinator timely means you will have to wait until the next regular open enrollment period.

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

Employees are no longer allowed to waive medical coverage for themselves (with the exception of those currently grandfathered in).  All employees must at least enroll themselves in Kaiser or Anthem Blue Cross.


life Insurance coverage for adult children

Beginning on their 21st birthday and each birth month after that until they turn 23, adult children must be a full-time student at an accredited institution to remain covered by the District's life insurance policy.  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 life insurance coverage will end.   

Student Certification Form 


Disabled Children

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 UNDER ALL PLANS regardless of age and/or student status.  Adult children who become disabled after age 26 and become dependent on you may be eligible for enrollment under the District's health and welfare plans.  Please contact or call 408.223.6713 immediately for more information and required documentation.   


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. ​​


Flexible Spending Accounts:

Medical Care Reimbursement Account 

  • The Medical Care Account Maximum has increased to $2,700.00 (the annual minimum is $240.00).
  • You will automatically rollover of up to $500 of unused 2018 contributions to be available for you to use in 2019 (even if you do not open an account for 2019).

Medical Care Reimbursement Account Flyer


Dependent Care Reimbursement Account

  • The annual maximum for 2019 remains at $5,000.00

This plan allows you to accumulate pre-tax dollars to reimburse yourself for childcare expenses, and/or day care expenses for a disabled dependent while you are employed. Among the eligible expenses are after-school care or extended day programs, babysitters, elder care expenses (if elder is your dependent), preschool and summer day camp.

Dependent Care Reimbursement Account Flyer

Transportation Account

  •  The maximum MONTHLY election allowed is $265.00

This plan allows you to set pre-taxed dollars aside reimbursement of certain transportation expenses incurred as a direct result of your employment.  If you take public transportation (CalTrain, Bart, VTA, etc.). 

Transportation Account Flyer

For more information about Flexible Spending Accounts including forms for additional cards, automatic deposit, and the Orthodontia Treatment Statement are available by scrolling down on this page to the Flexible Spending Account section.



Medical Care Reimbursement Account Carry Over FAQ

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 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


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

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

  • For All Enrollees (Active & Retired) 

Summaries are not available for medical plans tied to Medicare


​​​ Plan​ Website Customer Service Number

SISC - Anthem Blue Cross

    Navitus (Pharmacy)


1-800-322-5709 (See # on ID Card)



SISC - Kaiser

Chiropractic & Acupuncture Benefits (ASH Network)  


 1-800-678-9133 (TTY 711)

SISC - Delta Dental 1-866-499-3001




Company Code:

"SJECCD" (for Kaiser Senior Advantage Enrollees only)

"SISC" (for everyone else)

Hartford Life & LTD 1-800-572-9047
IGOE-Flexible Spending Account

Member ID: Your SSN

Employer ID: IGOSJCC

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

457 Plans



  CalPERS 457  

CalPERS Deferred Compensation 


1- 408-529-8846





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. 

Please see the Medicare Brochures below:

Applying Online for Medicare - Even if you Are Not Ready to Retire 2017

Medicare and You 2017

​Human Resources:

Where your Personal and Professional Lives Meet


The 2020 Flexible Spending Account Enrollment Period will be held in November 2019

SJECCD Supporting Page