Benefit Information for all eligible employees

• Medical, Dental and Vision Plan Rate Table

• Annual Stipend Information

• Active Employees Benefit Booklet 2021-2022

2021-2022 Medical Plan Comparisons

• Blue Shield PPO (80-E) Benefit Booklet

• Blue Shield PPO (80-J) Benefit Booklet

• Blue Shield PPO (HDHP-B) High Deductible Benefit Booklet

• Blue Shield HMO ($10-0) Benefit Booklet

• Blue Shield HMO ($25-500) Benefit Booklet

• Blue Shield HMO ($30-20%) Benefit Booklet

• Kaiser HMO Benefit Booklet

Medical Plan Benefit Information for Non-Benefit Eligible Employees:

• Anchor Bronze Benefit Booklet

Contact Information

Blue Shield:

• Customer Service: (855) 256-9404

• Address: P.O. Box 272540 Chico, CA 95927-2540

• Click here to locate a Participating PPO/HMO Provider

• Chiropractor and Acupuncture Benefits (HMO)

Kaiser Permanente:

• Customer Service: (800) 464-4000

• Delta Dental Evidence of Coverage (EOC)- Active Employees & Retirees

• Delta Dental Plan Highlights

Contact Information:

• Customer Service: (866) 499-3001

• Address: 100 First Street, San Francisco, CA 94105

• Claims: PO Box 7736, San Francisco, CA 94120

• Website: deltadentalins.com

• Active Group Number: 7046-7505

• Retiree Group Number: 7046-7506

Forms:

• Medical, Dental and Vision Plan Rate Table

• Summary of Benefits- Active Employees & Retirees

• Costco Benefit for VSP Vision Program

• Real Provider Choices through VSP Vision Program

Contact Information:

• Customer Service: (800) 877-7195

• Fax Number: (916) 851-4852

• Website: www.vsp.com

• Email: imember@vsp.com

• Active Group Number: TBD

To add a spouse and/or dependent children, provide the following:

• Copy of marriage certificate

• Copy of current year Federal Tax 1040 Form (top sheet only)

• Copy of birth certificate(s) (Children Only)

Employee Assistance Program (EAP)

• What is EAP?

• Get the most of your EAP benefits

Services:

• Summary of Services

• Childcare Resources

• Eldercare Resources

• Identity Theft

• Lean on Us

• Legal Services

• Learn to Live

• Work Life

Contact Information:

• Customer Service: (800) 999-7222

• Website: www.anthemEAP.com

• Company name: SISC

Life Insurance:

• President

• Certificated, Classified and Confidential Employees

• Classified and Educational Administrators

• Classified Employees, 20 hours per week, at least 9 months per year

• Beneficiary Form

Disability Insurance:

• Educational Administrators and Certificated Employees with 5 or more years of District service

• Educational Administrators, Certificated Employees and Classified Managers with less than 5 years of District service

• Classified and Confidential Employees

• Classified Employees, 20 hours per week, at least 9 months per year

Contact Information:

• Customer Service: (800) 289-9140

• Website: www.TheHartfordAtWork.com

• SISC Flex Plan Enrollment Guide 2022

• Maximum amounts that can be contributed for 2022:

• $2,750- Health Care Spending Account (increase from last year)

• $5,000- Dependent Care Spending Account

• $10 minimum per month for either account

• Frequently Asked Questions (FAQs)

Forms:

• Navia Health Care and Dependent Care Claim Form

• Navia Dependent Care Receipt for Services

• Recurring Day Care Claim Form

• Letter of Medical Necessity

• Direct Deposit Request Form

• Navia Flex Change Form

Contact Information:

• Dependent Care

• Dependent Care Eligible Expenses

• Unreimbursed Medical Program

• Unreimbursed Medical Program Eligible Expenses

• Customer Service: (425) 452-3500 or Toll-Free: (800) 669-3559

• Website: www.naviabenefits.com

• Mobile App Available

Submit a Claim:

• Email: claims@naviabenefits.com

• Fax: (425) 451-7002 or Toll Free: (866) 535-9227

• Address: P.O. Box 53250, Bellevue, WA 98015-3250

• Retiree Benefits and Medicare- FAQs

• Medical, Dental and Vision Plan Rate Table

• Retiree Employees Benefit Booklet 2021-2022

Medical Plans

Blue Shield PPO/HMO Medical Plan Comparison for Retirees Age 65+

Blue Shield PPO/HMO Medical Plan Comparison for Retirees Under Age 65

• Blue Shield PPO (100-A $0) Benefit Booklet (Age 65+)

• Blue Shield PPO (100-G $20) Benefit Booklet (Age 65+)

• Blue Shield PPO (80-E) Benefit Booklet

• Blue Shield PPO (80-J) Benefit Booklet

• Blue Shield PPO (HDHP-B) High Deductible Benefit Booklet

• Blue Shield HMO ($10-0) Benefit Booklet

• Blue Shield HMO ($25-500) Benefit Booklet

• Blue Shield HMO ($30-20%) Benefit Booklet

• Blue Shield HMO (Age 65+) Benefit Booklet

• Kaiser Senior Advantage HMO Benefit Booklet

• CompanionCare Supplemental Medical Benefit Booklet

Contact Information:

• Anthem Blue Cross Customer Service: (800) 825-5541

• Blue Shield Customer Service: (800) 642-6155

• Blue Shield Address: P.O. Box 272540 Chico, CA 95927-2540

• Blue Shield MDLIVE: (888) 632-2738

• Mental Health: (800) 256-9404

• SISC Dedicated Customer Service Unit: (855) 599-2657

• Kaiser Permante Customer Service: (800) 443-0815

• Click here to locate a participating PPO/HMO Provider

• Chiropractor and Acupuncture Benefits (HMO)

• Medicare

Dental Plans

Rates effective October 1, 2020:

Dental Monthly Self-Pay Premiums:

• Single: $63.80

• 2-Person: $115.50

• Family: $166.10

• Plan Highlights

• Retiree Dental Group Number: 7046-7506

Contact Information:

• Customer Service: (888) 335-8227

• Claims: P.O. Box 7736 San Francisco, CA 94120

Vision Plans

Rates effective October 1, 2020:

VSP Vision Monthly Self-Pay Premiums:

• Single: $8.80

• 2-Person: $17.60

• Family: $28.40

• Retiree Rate Table

• Retiree Group Number: TBD

Contact Information:

• Customer Service: (800) 877-7195

• Fax Number: (916) 851-4852

• Website: www.vsp.com

• Email: imember@vsp.com

• 2021/2022 Annual Notices for Employees

• Covered California Website

• Covered California Notice

• Health Care Reform Website