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Insurance Information

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Insurance Information - Active Employees

MEDICAL

2018 Medical Plan Premium Rates – Active Full-Time Employees

2018 Medical Plan Premium Rates – ACA Eligible Part-Time Employees

2018 Blue Shield HMO Enrollment Form

2018 Blue Shield HMO Plan Summary

2018 Blue Shield HMO SBC

2018 Blue Shield PPO Enrollment Form

2018 Blue Shield PPO Plan Summary

2018 Blue Shield PPO SBC

2018 Kaiser HMO Enrollment Form

2018 Kaiser HMO Plan Summary

2018 Kaiser HMO SBC

2018 ACA Eligible Part-Time Employees Election Form

2018 Cash-In-Lieu Form

DENTAL

Ameritas Enrollment Form

Ameritas Dental Highlights & Certificate

Ameritas Privacy Notice (English)

Ameritas Privacy Notice (Spanish)

Ameritas Vision Materials Reimbursement Request Form

Ameritas Notice for the California Language Assistance Program

Ameritas GLB Notice (English)

Ameritas GLB Notice (Spanish)

VISION

VSP Enrollment Form

VSP Member Benefits Summary

VSP Out-of-Network Claim Form

VSP How to Register for Member Access

VSP Extra $20 Flier with Coupon

VSP TruHearing Hearing Aid Discount Program

VSP Better Provider Choices

Insurance Information - Retirees Under Age 65

Retiree Medical Benefits Contribution & Eligibility Information

2018 Medical Plan Premium Rates & Contributions – Tier I Retirees Under 65

2018 Medical Plan Premium Rates & Contributions – Tier II Retirees Under 65

2018 Blue Shield HMO Enrollment Form

2018 Blue Shield HMO Plan Summary

2018 Blue Shield HMO SBC

2018 Blue Shield PPO Enrollment Form

2018 Blue Shield PPO Plan Summary

2018 Blue Shield PPO SBC

2018 Kaiser HMO Enrollment Form

2018 Kaiser HMO Plan Summary

2018 Kaiser HMO SBC

Insurance Information - Retirees Age 65 & Older

Retiree Medical Benefits Contribution & Eligibility Information

2018 Medical Plan Premium Rates & Contributions – Tier I Retirees Post 65

2018 Medical Plan Premium Rates & Contributions – Tier II Retirees Post 65

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