Active Employee Benefit Rates 2024-2025
Active Employee Benefits Overview
Retiree Benefits Overview
Domestic Partner Affidavit
Domestic Partner Termination
Cash Election Form
Child Abuse Reporting Statement
Child Abuse Reporting Statement - Penal Codes
Deleting Group Heath Coverage Form
Direct Deposit Authorization Form
Educational Stipend Application
Employees Withholding Allowance Certificate
Employment Eligibility Verification, Form I-9
Medical Examination Report
Oath of Allegience
Personal Information Sheet
Pre-Employment Packet - District Office
Request for Reasonable Accommodation Form - Employee
STRS-PERS Information Supplemental Questionnaire
Transfer of Sick Leave
Universal Benefit Enrollment-Change Form - Active Employees
W-4 2022
Adjunct Faculty Maternity Leave Form
Leave Planning - Check List
Optional Catastrophic Leave Program Participation Request Form - Unrepresented Employee Groups
Parental Leave AB2393 Form
Request for Family and Medical Leave Act or Pregnancy Disability Leave
Request to use Optional Catastrophic Leave and Medical Certification Form
Sick Leave Donation Form
Voluntary Emergency Leave Program Participation Request Form - Local 1
DeltaCare USA - Combined Evidence of Coverage and Disclosure Form
DeltaCare USA - Participating Dental Offices
DeltaCare USA - Plan Details
Delta Dental PPO Plan Summary
Part-Time Faculty Cost of Coverage
Part-Time Instructors Open Enrollment Memorandum 2022-2023
Part-Time Instructors - Universal Benefit Enrollment-Change Form - Adjunct Faculty
VSP Vision Benefits Summary
Adjunct Professor Retirement Health Benefit Continue or Discontinue Form
Anthem Medicare, Evidence of Coverage, 2020-2021
Anthem Medicare Handbook and Plan Summary, 2020-2021
Anthem Medicare Preferred, PPO, with Senior Rx Plus - Enrollment Form
Anthem SilverSneakers Information
Employee Retirement Health Benefit Continue or Discontinue Form
Kaiser Permanente CHIROPRACTIC benefits
Kaiser Permanente Senior Advantage (HMO) Group Medicare Election Form
Kaiser Permanente Senior Advantage (HMO) with Part D
Kaiser Permanente Senior Advantage (HMO) with Part D Evidence of Coverage
Kaiser Permanente Senior Advantage Frequently Asked Questions
Kaiser Senior Advantage Silver&fit Evidence of Coverage.
Kaiser SilverFit Program Information
Kaiser Travel Coverage, Emergency and Urgent Care Away From Home
Retiree Cash Payment in Lieu of Medical Insurance Election Form
Retiree Enrollment Form - Vision Services and Employee Assistance Voluntary Plan
Retiree Surviving Spouse Continue or Discontinue Form
Retiree VSP Benefits Summary
Retirement Checklist - Cal PERS
Retirement Checklist - Cal STRS
Retirement Point Calculator
TruHearing - Hearing Aid Discount Program
Universal Benefit Enrollment/Change Form (Retirees)
Universal Benefit Enrollment/Change Form (Surviving Spouse)
24 Hour Fitness Special Rates for CCCSIG Members
Active&Fit Direct Member FAQs
Active&Fit Direct Membership Discount
Anthem - Coronavirus FAQ
Anthem - COVID-19 symptoms - Sydney Care Mobile App
Anthem - Disabled Dependents Form
Anthem - EPO - Plan Details - Evidence of Coverage
Anthem - EPO - Plan Summary 2020-2021
Anthem - IngenioRx Prescription Mail Order Delivery Flyer
Anthem - Live Health Online 2020
Anthem - Live Health Online - COVID-19 ABC
Anthem - Online Evidence of Coverage and Cert of Insurance
Anthem - Online Find a Doctor
Anthem - Online LiveHealth Mobile App Instructions
Anthem - Prescription Home Delivery Information
Anthem - Prescription Home Delivery Order Form
Anthem - Prescription - IngenioRx Transition ABC Client Guide
Anthem - Summary of Benefits, Copayments - Office Visits etc - 2020-2021
Anthem - Summary of Benefits, Copayments - Prescriptions - 2020-2021
Anthem - Travel International Claim Form
Anthem - Travel Outside the US Information
Anthem - Video Visit and Telemedicine
Delta Dental - amplifon Hearing Health Care
Delta Dental - Benefits Summary
Delta Dental - Claim Form
Delta Dental - Cost Estimator
Delta Dental - FAQ and Fees
Delta Dental - Hearing Aid and LASIK Discount
Delta Dental - LASIK Eye Surgery
Delta Dental - Value Added Features
EAP Plus with Coaching
EAP Therapy - What to Expect
Adding More Activity to Your Life
August Weight Management - English
August Weight Management - Spanish
August Weight Management Wellness Resources
Cutting Unhealthy Fats From Your Diet
Getting Active as a Family
Kaiser 3 ways to stay healthy this season
Kaiser Bienestar de la mente y el cuerpo
Kaiser Chiropractic Benefits Evidence of Coverage
Kaiser Chiropractic Benefits Summary
Kaiser Claim for Emergency Services
Kaiser Cold, flu, or COVID-19: Know the symptoms
Kaiser Connect with a Wellness Coach
Kaiser Discounts
Kaiser Explore Healthy Resources
Kaiser Flu Shot Information
Kaiser HMO Complementary Care
Kaiser How to Practice Mindful Meditation
Kaiser List of Facilities
Kaiser Locating Services
Kaiser Manage Your Health, Online Anytime
Kaiser Medicare 101: Understanding the Basics
Kaiser Mental Health and Wellness Services
Kaiser Mind-Body Wellness
Kaiser Mind-Body Wellness Resources
Kaiser Mindfulness Before Sleep
Kaiser My Doctor Online App
Kaiser My KP Meds App
Kaiser Permanente Senior Advantage (HMO) Enrollment Form
Kaiser Permanente Traditional HMO Plan - Evidence of Coverage
Kaiser Permanente Traditional HMO Plan - Principal Benefits
Kaiser Special Open Enrollment Rights for Certain Individuals
Kaiser The Mind-Body Connection
Kaiser Vaccines - What they are and how they can save your life
Kaiser Value Added Benefits Presentation
Kaiser Video Visit and Telemedicine
Kaiser Visiting Member Program
Adding Direct Deposit
Anthem Medicare Copay Reimbursement Request Form
Day Care Claim Form
Day Care FSA Receipt for Services
Direct Debit & Credit Authorization Agreement
Direct Deposit Request Form
Flexible Spending Account (FSA) Day Care Booklet
Flexible Spending Account (FSA) Fill-in Enrollment Form
Flexible Spending Account (FSA) Healthcare Booklet
GoNavia Commuter Booklet
GoNavia Parking Benefit
GoNavia Sign-Up Instructions
GoNavia Sign-Up Instructions (Español)
GoNavia Transit Benefit
Health Reimbursement Arrangement (HRA) Enrollment Form
How to setup the MyNavia App in 4 easy steps
How to Submit a Claim
Local 1 Co-pay Reimbursement Request Form
Medicare Part B Reimbursement Request Form
Report a Lost or Stolen Card
United Faculty Co-pay Reimbursement Request Form
Employer-Paid Long-Term Disability Insurance
Evidence of Insurability Application - Health Questionnaire
Evidence of Insurability Cover Page
Life and Accidental Death and Dismemberment (AD&D)
Notice of Group Life Conversion and Portability
Optional Life Insurance - Electing Plan 1
Optional Life Insurance - Electing Plan 2
Portability vs Conversion for Separating Employees
Sun Life Additional Optional Life Enrollment Form plus EOI
Sun Life Beneficiary Designation Form
Sun Life Disability Claim Statement - Attending Physician
Sun Life Disability Claim Statement - Employee
Sun Life Disability Claim Statement - Employer
Sun Life Emergency Travel Assistance Services
Sun Life Evidence of Insurability How to Submit EOI Online
Sun Life Expatriate Coverage, FAQs
Sun Life Expatriate Coverage Form
Sun Life Expatriate Coverage Information
Sun Life Group Enrollment Form
Sun Life Long-Time Disability Details
Sun Life Optional Life Enrollment Form
Sun Life Refusal of Non-Contributory Group Coverage Waiver
Sun Life SecurAssist Enrollment Information and Procedures
VSP Benefits Summary
VSP Enrollment Form
VSP Essential Medical Eye Care Services
VSP Member Reimbursement Form
VSP Providers
VSP TruHearing
CalPERS Address Change Authorization
CalPERS - Beneficiary Designation form
CalPERS Disability Retirement Election Application
CalPERS How to Register for my CalPERS
CalPERS On-line Guide to Downloading CalPERS Retirement Documents to Begin the Retirement Process
CalPERS Special Power of Attorney
CalPERS What You Need to Know About Your CalPERS School Benefits
CalPERS Workshop Enrollment Instructions
CalSTRS Address Change Request
CalSTRS-CalPERS Questionnaire
CalSTRS One-Time Death Benefit Recipient Form
CalSTRS Recipient Designation Information, One-Time Death Benefit, Cash Balance Lump-Sum Payment
CalSTRS Register to Access, Manage Personal Information
403-b and 457 Plan Vendor List
CalPERS Supplemental Income 457 Plan
CalPERS Supplemental Income 457 Plan - Beneficiary Form
CalPERS Supplemental Income 457 Plan - Employee New Enrollment Form
CalPERS Supplemental Income 457 Plan - Enrollment Kit
CalSTRS 403-b Enrollment Form
CalSTRS Loan Request
Easy Steps for Tax Sheltered Annuities - New Accounts and Rollovers
Meet Your CalPERS 457 Account Manager
CCCSIG Company Nurse Injury Hotline
CCCSIG Workers Compensation Medical Panels
Pre-designation of Personal Physician
