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Insurance Information
2018 Open Enrollment Information

Open enrollment for the 2018 plan year will be from November 1, 2017 through November 27, 2017. Blue Shield and Kaiser representatives will be available on November 16, 2017 from 10:00 a.m. to 2:00 p.m. for to answer any questions about their plans. Spouses are welcome to attend with employees.

Rates

Active Full-Time Employees

ACA Eligible Part-Time Employees

Tier I Retirees Under 65

Tier I Retirees Post 65

Tier II Retirees Under 65

Tier II Retirees Post 65


Enrollment Forms

2018 Kaiser HMO Enrollment Form

2018 Blue Shield HMO Enrollment Form

2018 Blue Shield PPO Enrollment Form

Cash-In-Lieu Form

2018 ACA Eligible Part-Time Employees Election Form


Plan Summaries

2018 Kaiser HMO - Summary

2018 Blue Shield HMO - Summary

2018 Blue Shield PPO - Summary


Summary of Benefits & Coverage Documents

2018 Kaiser HMO

2018 Blue Shield HMO

2018 Blue Shield PPO



Dental Plans

Ameritas Enrollment Form

Ameritas Highlights & Certificate - Eligible Employees

Ameritas Dental Highlights & Certificate - Council Members

Ameritas Privacy Notice (English)

Ameritas Privacy Notice (Spanish)

Ameritas Fusion Vision Gap Benefit Claim Form

Ameritas Notice for the California Language Assistance Program

 

Vision Plan

VSP Enrollment Form

VSP Benefits & Evidence of Coverage

VSP Out-of-Network Claim Form

 

Long Term Disability (LTD) & Life Insurance Plans

Hartford LTD & Life Enrollment Form

Hartford Beneficiary Designation Form

Hartford LTD Summary

Hartford Life Insurance Summary - Executive Management

Hartford Life Insurance Summary - All Other Employees

Hartford Life Insurance Summary - Council Members

Hartford Life Insurance Additional Benefits

Hartford LTD & Life Insurance Combined Certificate

Hartford Executive Management Endorsement

Hartford Council Member Endorsement

Hartford Supplemental Life Insurance Enrollment Form

Hartford Supplemental Life Insurance Evidence of Insurability Form

Hartford Supplemental Life Insurance Benefits Summary

 

Insurance Information - Retirees Under Age 65

Retiree Medical Benefits Contribution & Eligibility Information

2017 Medical Plan Premium Rates & Contributions - Tier I Retirees Under Age 65

2017 Medical Plan Premium Rates & Contributions - Tier II Retirees Under Age 65

Anthem HMO Enrollment Form

Anthem HMO SBC (2017)

Anthem HMO Plan Summary (2017)

Anthem PPO Enrollment Form

Anthem PPO SBC (2017)

Anthem PPO Plan Summary (2017)

Kaiser Enrollment Form

Kaiser SBC (2017)

Kaiser Plan Summary (2017)

 

Insurance Information - Retirees Age 65 & Older

Retiree Medical Benefits Contribution & Eligibility Information

2017 Medical Plan Premium Rates & Contributions - Tier I Retirees Age 65 & Older

2017 Medical Plan Premium Rates & Contributions - Tier II Retirees Age 65 & Older

Benistar-Hartford Enrollment Form

2017 Benistar-Hartford Medicare Supplement Benefits Summary

2017 Benistar-Hartford Express Scripts Pharmacy Benefits Overview

2017 Benistar-Hartford Express Scripts 5-Tier Formulary