Senior Benefits Analyst
|415.883.2211 ext. 8159
Fiscal Services Director
|415.883.2211 ext. 8160
|Fiscal Services Administration|
Monday, June 29, 2015 – Tuesday, August 25, 2015
Deadline: Tuesday, August 25, 2015, 5 pm at IVC
We are pleased to announce the 2015-2016 Annual Open Enrollment for all benefit eligible employees. Open Enrollment will be held Monday, June 29, 2015 through Tuesday, August 25, 2015. Any enrollment changes for you or your dependents will go into effect on October 1, 2015, with any employee premium contributions beginning on the September 2015 payroll. The district caps remain unchanged.
GOOD NEWS – For plan year 2015-2016, the overall rate increase is 1.56%.
If you are satisfied with your current coverage, there will be no action needed.
Flex Week Open Enrollment Sessions for Health Benefits
Tuesday, August 11, 2015 – 11 a.m. KTD (Room TBD)
Tuesday, August 11, 2015 – 1 p.m. KTD (Room TBD)
Tuesday, August 11, 2015 – 3 p.m. IVC (Room TBD)
Open Enrollment Guide for Traditional Kaiser Permanente plans
Open Enrollment Guide for Deductible HMO Kaiser Permanente plans
Kaiser's List of Covered Zip Codes for the Northern California Service Area
Blue Shield PPO
SISC Blue Shield of California 100% Plan A / $20.00 Copayment (update pending)
SISC Blue Shield of California 80% Plan K / $30.00 Copayment (update pending)
Open Enrollment Guide for Blue Shield PPO plans (2015-2016 Enrollment Guide - update pending)
Open Enrollment Forms
Step 1: Complete Medical Plan Election Form
Step 2: Complete Enrollment Forms
- Kaiser Enrollment Form (includes dental and vision enrollment)
- Kaiser Senior Advantage Election Form (for Senior Advantage only)
- Blue Shield Enrollment Form (includes dental and vision enrollment)
- Dental & Vision Enrollment Form (complete this form ONLY if you were hired prior to June 1, 2014 and you are waiving medical coverage but wish to participate in the dental and vision plans)
Step 3: Provide Required Dependent Eligibility Information
- Definitions of AB205 and non-AB205 Domestic Partnerships
- Affidavit of Domestic Partnership
- Affidavit of Termination of Domestic Partnership
Other: Complete Agreement to Save Taxes on Premiums (complete Option 3 on this form)
Open Enrollment for Pre-Tax Benefit Enrollment - Aflac and WageWorks
Flexible Spending Account (FSA)
Flexible Spending Account - For Permanent Employees: If you have any out of pocket share toward the premium, you may want to consider having the deductions taken on a pre-tax basis. By signing up for this option your federal, state and social security deductions will decrease. Please complete, sign and return the FSA Enrollment form below to the Benefits Office, Fiscal Services at IVC by Tuesday, August 25, 2015.
For additional information on the FSA/Dependent Care Programs, please visit the Wage Works website. If you have additional questions, please call Wage Works Customer Service at 1.800.950.0105; please request to speak with an agent even if you are not a current participant.
Please submit completed forms to the Benefits Office, Fiscal Services by Tuesday, August 25, 2015.
Commuter Benefits Program
Bay Area Commuter Benefits Program: Claim up to $130 per month of transit or van pooling expenses
For additional information on the Commuter Benefits Program, please visit the Wage Works website. If you have additional questions, please call Wage Works Customer Service at 1.800.950.0105; please request to speak with an agent even if you are not a current participant.
Please submit completed forms to Fiscal Services by Tuesday, August 25, 2015.
Aflac Accident and Cancer Plans
If you are a current policyholder you with Accident, Cancer, or Disability Plans, there is no action required. Your plan(s) will automatically rollover.
If you are not currently enrolled in Aflac Plans, review the information below.
Accident Indemnity Coverage: A cash benefit for injury on or off the job.
Cancer Indemnity Coverage: Cash benefits in the event of cancer diagnosis and annual cancer screening benefits.
For additional information on Aflac's Accident and Cancer In de mi ties please follow the links above. If you have additional questions, please contact the District's Aflac Representative, Donna Reeve 415.250.0540.
Resources and Contact Information
KAISER – Group #554
Get immediate assistance to your routine questions by calling KP Member Services at 800-464-4000.
Contact your Member Services Team at 1-800-642-6155.
Visit web site: www.deltadentalins.com/enrollees
Call 1-800-877-7195 for details on your vision plan or go to www.vsp.com
Self-Insured Schools of California
Visit web site: http://sisc.kern.org/hw/
For specific questions please contact Ron Owen, Sr. Benefits Analyst at extension 8159 or (415) 884-3159.
Content Responsible: Peggy Isozaki, Director of Fiscal Services, 415.883.2211 ext. 8160
Technical Contact: Melinda Molloy, Executive Assistant to the Vice President of College Operations, 415.883.2211 ext. 8101