Human Resources - Benefits

	Active Employee Benefit Rates, Fiscal Year 2020-2021
	Full-Time Employee Health Benefits

	Local 1 Co-pay Reimbursement Request Form
	United Faculty Co-pay Reimbursement Request Form

	Domestic Partner Affidavit
	Domestic Partner Termination

	Cash Election Form
	Change of Personal Information Form
	Child Abuse Reporting Statement
	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
	Request for Reasonable Accommodation Form - Employee
	STRS-PERS Information Supplemental Questionnaire
	Transfer of Sick Leave
	Universal Benefit Enrollment-Change Form - Active Employees

	Adjunct Faculty Maternity Leave Form
	Leave Planning - Check List
	Optional Catastrophic Leave Program, Participation Request Form - Local 1
	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

	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 Instructors and Non-Instructional Faculty - Open Enrollment Memorandum 2020-2021
	Part-Time Instructors and Non-Instructional Faculty - Open Enrollment Memorandum Spring 2021
	Part-Time Instructors - Cost of Coverage
	Part-Time Instructors - Universal Benefit Enrollment-Change Form - Adjunct Faculty
	VSP Vision Benefits Summary

	Anthem Medicare, Evidence of Coverage, 2020-2021
	Anthem Medicare Handbook and Plan Summary, 2020-2021
	Anthem Medicare PPO Plan Retiree Co-pay Reimbursement Request Form
	Anthem Medicare Preferred, PPO, with Senior Rx Plus - Enrollment Form
	Anthem SilverSneakers Information
	Employee Retirement Health Benefit Form
	Kaiser Permanente Senior Advantage, HMO, with Part D - Principle Benefits
	Kaiser Permanente Senior Advantage Frequently Asked Questions
	Kaiser Permanente Senior Advantage (HMO) Form 2021
	Kaiser SilverFit Program Information
	Medicare Part B Reimbursement Form
	Retiree Cash Payment in Lieu of Medical Insurance Election Form
	Retiree Enrollment Form - Vision Services and Employee Assistance Voluntary Plan
	Retiree Premium Rates 2020-2021
	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

	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 - Claim Form
	Delta Dental - Cost Estimator
	Delta Dental - FAQ and Fees
	Delta Dental - LASIK Eye Surgery
	Delta Dental - Retiree Benefits Summary
	Delta Dental - Value Added Features

	Childcare and Elderly Services Information
	Coping with grief after losing someone important to you
	Coping with loss when someone in the workplace dies
	EAP Detailed Plan Description
	EAP Employee Assistance Program Information
	EAP Financial Services
	EAP Guide to Accessing the Employee Assistance Program - MHN
	EAP Identity Theft Information
	EAP Legal Services Information
	EAP Member Website Information
	EAP Plan Summary - English
	EAP Plan Summary - Spanish
	EAP Student Assistance Program

	Section 125 Flexible Benefit Plan Claim Form
	Section 125 Flexible Benefit Plan Election Form
	Section 125 Flexible Benefit Plan Employee Handbook 2021 and After
	Section 132 PreTax Commuter Expense Program Employee Handbook 2021 and After

	Kaiser Chiropractic Benefits 2020-2021
	Kaiser Chiropractic Services Amendment 2020-2021
	Kaiser Claim for Emergency Services
	Kaiser Discounts
	Kaiser Explore Healthy Resources
	Kaiser Flu Shot Information
	Kaiser List of Facilities
	Kaiser Locating Services
	Kaiser Manage Your Health, Online Anytime
	Kaiser Mental Health and Wellness Services
	Kaiser My Doctor Online App
	Kaiser My KP Meds App
	Kaiser Permanente Traditional HMO Plan, Evidence of Coverage
	Kaiser Principal Benefits for Traditional HMO Plan 2020-2021
	Kaiser Special Open Enrollment Rights for Certain Individuals
	Kaiser Travel Coverage, Emergency and Urgent Care Away From Home
	Kaiser Value Added Benefits Presentation
	Kaiser Video Visit and Telemedicine
	Kaiser Visiting Member Program

	Sun Life Additional Optional Life Enrollment Form plus EOI
	Sun Life Beneficiary Designation Form
	Sun Life Emergency Travel Assistance Services
	Sun Life Evidence of Insurability How to Submit EOI Online
	Sun Life Evidence of Insurability Questionnaire
	Sun Life Expatriate Coverage, FAQs
	Sun Life Expatriate Coverage Form
	Sun Life Expatriate Coverage Information
	Sun Life Group Enrollment Form
	Sun Life Group Life Conversion Employee Kit
	Sun Life Group Life Insurance Details
	Sun Life Long-Term Disability Claim Packet - Attending Physician
	Sun Life Long-Term Disability Claim Packet - Claimant
	Sun Life Long-Term Disability Claim Packet - Employer
	Sun Life Long-Time Disability Details
	Sun Life Notice of Group Life Conversion
	Sun Life Optional Life Enrollment Form
	Sun Life Refusal of Non-Contributory Group Coverage
	Sun Life SecurAssist Enrollment Information and Procedures

	VSP Benefits Summary
	VSP Enrollment Form
	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
	Payroll Deduction Authorization Form

	CCCSIG Company Nurse Injury Hotline
	CCCSIG Workers Compensation Medical Panels
	Pre-designation of Personal Physician

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