Welcome to Your Benefits Webpage!

Contact Information for Benefit Plans and Retirement 
Carriers Effective 10/1/2018

A printable list is available by clicking here.

​​​Plan​	Website	Customer Service Number
SISC - Anthem Blue Cross Navitus (Pharmacy) MDLive	www.anthem.com/ca/sisc www.navitus.com www.mdlive.com/sisc	1-800-322-5709 (See # on ID Card) 1-866-333-2757 1-888-632-2738
SISC - Kaiser Chiropractic & Acupuncture Benefits (ASH Network)	www.kp.org www.ashlink.com/ash/kp	1-800-464-4000 1-800-678-9133 (TTY 711)
SISC - Delta Dental	www.deltadentalins.com	1-866-499-3001
SISC - VSP	www.vsp.com	1-800-877-7195
SISC - EAP	www.anthemEAP.com Company Code: "SJECCD" (for Kaiser Senior Advantage Enrollees only) "SISC" (for everyone else)	1-800-999-7222
Hartford Life & LTD	www.thehartford.com	1-800-572-9047
IGOE-Flexible Spending Account	www.goigoe.com Member ID: Your SSN Employer ID: IGOSJCC	800- 633-8818, Opt# 1
PERS	www.calpers.ca.gov	1-888-225-7377
STRS	www.calstrs.com	1-800-228-5453
The TDS Group (403b Administrators)	www.tdsgroup.org	1-866- 446-1072, Option #4
457 Plans VALIC TIAA-CREF CalPERS 457	www.valic.com www.tiaa-cref.org CalPERS Deferred Compensation	1- 408-529-8846 1-800-842-2252 1-800-260-0659

Coming Soon:

2025 Enrollment Period for

FLEXIBLE SPENDING ACCOUNTS

Opposite Sex Domestic Partners Now Eligible

Those of you with an opposite sex domestic partner that are registered with the State of California as Domestic Partners may now enroll your partner under the District’s plan(s). If you are not already registered, you may do so by clicking here https://www.sos.ca.gov/registries/domestic-partners-registry/. Simply provide a completed SISC III Member Change Form and a copy of your certificate of registry within 30 days of becoming registered or you may have to wait until the 2023 OE period unless they have a qualifying event.

Sending Protected Information Through Email

If you have an enrollment form or change form to submit to the Benefits Office, please send it through Office 365 and "Encrypt" the email prior to sending it. This will ensure protected information like dates of birth and social security numbers are sent securely. It is very simple just a click of a link but if you do not have access to that function, simply email HR.Benefits@sjeccd.edu and request an encrypted email to reply to.

Associate Faculty Benefits

 See the Associate Faculty Benefits Page for more information.

Adding Or Removing Dependents

Completion and submission of the following form is required to add or remove a covered dependent from your medical, dental, and/or vision plan.  Outside of Open Enrollment, supporting documentation is also required (ie., dissolution of marriage, birth certificate, etc.)

 

Member Change Form (for both Kaiser and Anthem Blue Cross members)

Workspace Ergonomic Resources

Whether you are working remotely or in the workplace, make sure your workspace(s) is/are set up properly. The best way to reduce fatigue, burn out, and ultimately injury is for you to set up the tools/equipment you have, in the best way possible for you. The following flyers will help you do that.

Think Ergonomics (desktop) - Helpful tips to help you customize your workstation when using a desktop computer.

Think Ergonomics (laptop) - Helpful tips to help you customize your workstation when using a laptop computer.

Sit/Stand Workstation - Helpful tips to assure your sit/stand device is adjusted and used properly.

Easy Ergonomics - a helpful guide put out by Cal OSHA to help you learn how to work safely and reduce your risk of injury.

Please channel any requests you may have for special or different equipment through your immediate supervisor. If you need special assistance or require a formal ergonomic evaluation feel free to email Benefits Coordinator Michelle McKay at michelle.mckay@sjeccd.edu.

Welcome New Employees!!

For those of you eligible for health and welfare benefits, please review the Benefits Guide Book for information on all the benefit plans (including optional benefits) available to you. Enrollment forms will be sent to you prior to your benefit orientation. Additional details on each plan can be found by scrolling down this page and will be discussed during your New Employee Orientation.

Benefits Guide (flip) Book

Benefit Plans for Active Employees

Medical Plans

Anthem Blue Cross

Anthem Blue Cross and Stanford have settled their contract retroactive to 9/1/2022 (no lapse). If you have questions, please call Anthem directly or your doctor's office at Stanford Health.

(Enrollment Packet for ALL benefit eligible Active employees)

• Active Employee's Plan Summary including Prescription Coverage (Anthem Blue Cross)
• Active Employee's Enrollment Guidebook (Anthem Blue Cross)
• Costco Mail Order Prescription Form (Anthem Blue Cross Enrollees Only)
• Anthem Mobile App Instructions
• Anthem Hip, Knee & Spine Surgeries (Blue Distinction REQUIREMENTS)
• SISC III Enrollment Form (Anthem Blue Cross) to print and sign
• SISC III Enrollment Form (Anthem Blue Cross) for digital signatures
• SISC III Membership Change Form (to add/terminate dependents, update address/name) to print and sign
• Anthem In-Network Labs (SISC)
• How to Print a Temporary ID Card (Anthem Blue Cross only)

Kaiser Permanente

(Enrollment Packet for ALL benefit eligible employees - including Plan A for associate faculty)

• Kaiser Enrollment Form (for digital signatures)
• Active Employee's Plan Summary (Kaiser)
• Chiropractic & Acupuncture Benefits

Dental Plan

There is no annual cap for basic services and tiered. Basic Services are covered at 70% (first year), then each year you use the plan your coverage increases until you hit 100%. Orthodontia is covered at 100% up to a lifetime maximum of $3,000. Bridges and dentures however are covered at 50%. Below is a plan summary. Seeing a dentist that is part of Delta's PPO Network will provide you with the least out of pocket expense.

Delta Dental Plan Summary

Vision Plan

VSP is our vision plan. You get one comprehensive exam every 12 months, glasses or contact lenses every 24 months. There is little to no out of network coverage so be sure you find a provider at www.vsp.com

VSP Plan Summary

VSP TruHearing Hearing Aid Discount Program

Employee Assistance Plan (EAP)

AnthemEAP plans offer confidential counseling services to all our benefit eligible employees and covered retirees, their dependents and anyone living in the employee/covered retiree's household. Telephonic, electronic (like Facetime or Skype), and in person counseling services are available, as are legal services, financial planning services, child care assistance, elder care assistance, discounted tickets for movies and attractions, etc., as are resources for tobacco, alcohol and drug dependency and our over all emotional health and mental wellness.

EAP Overview	Identity Theft Flyer
Child Care Resources	Legal & Financial Services Flyer
Elder Care Resources	Substance Abuse Flyer
Depression Resources Flyer	Work-Life Flyer

Benefit Plans for Eligible Retirees 

Anthem Blue Cross

• Retiree Plan Summary (For all Covered Retirees eff 7/1/2018)
• EAP Plan (See EAP section above for more information on benefits/services available)

Kaiser Permanente

• Early Retiree Plan Summary (<65)
• EAP Plan (information for those <65) 
• Senior Advantage Plan Summary (Retirees 65+)
• Kaiser Senior Advantage Enrollment Form (for All Kaiser Enrollees >65)
• AnthemEAP for Kaiser Senior Advantage Enrollees Only

Additional Information

Address, Name, and Dependent Changes:

To change your address, name, add/remove a dependent please print, complete, sign and return the form below to HR.Benefits@sjeccd.edu, fax to 408.239.8804, or mail it via the Pony or US Mail to

Michelle McKay, Human Resources, 40 South Market Street San Jose, CA 95113.

SISC III Member Change Form

Adding/Removing Dependents

Adding Dependents:

Adding an eligible dependent that is not currently covered under your medical, dental and/or vision plan requires a completed original enrollment form and:

• To add a spouse: a copy of your previous year's Federal Tax Return (first page, redacted financial info)
• To add a domestic partner: a copy of your State Registration form (applies to same sex couples only unless one is 62 or older);
• To add your child (adopted, biological, or step): a copy of his/her certified birth certificate and:
• For all plans: SISC Member Change Form

YOU MUST ENROLL YOUR NEW DEPENDENT(S) WITHIN 30 DAYS OF THE EVENT (birth, marriage, adoption, etc.) or you may not be able to enroll them until the next regular Open Enrollment Period. ​

Removing Dependents:

As a reminder, it is the employee’s responsibility to notify the Benefits Coordinator in Human Resources within 60 days of the event if you have a covered dependent that ceases to be your dependent; for example:

• You get divorced.
• Your child between the ages of 19 – 25, gets married or is not a full time student at an accredited institution. (They can remain on Blue Cross or Kaiser, but not dental, vision, the EAP or life insurance). It is your responsibility to notify Human Resources timely.
• Your child becomes an active member of the military.

Failure to timely notify the District (by emailing the Benefits Coordinator in Human Resources) will result in loss of continuation coverage rights under COBRA and may include the carrier(s) billing you for services the ineligible dependent received and/or reimbursement of District paid premiums.

For specific eligibility questions contact the HR Benefits Office at extension 6713 or HR.Benefits@sjeccd.edu.

• For all plans: SISC Member Change Form

Loss of Coverage/Qualifying Events

Health Insurance Portability & Accountability Act (HIPAA): For those eligible to decline enrollment for themselves, or any employee who elected to not enroll an eligible dependent (spouse, child, domestic partner) because of enrollment in another health insurance plan, you may be able to enroll yourself and your dependents in a District plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents' other coverage) IF you request enrollment within 30 days after your or your dependents' other coverage ends (or after the employer stops contributing toward the other coverage). Failure to notify the Benefits Coordinator timely means you will have to wait until the next regular open enrollment period.

In addition, if you have a new dependent as a result of marriage, birth, adoption or placement for adoption, you may be able to enroll yourself and your dependents. However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption.

To request special enrollment or obtain more information, contact Michelle McKay, Benefits Coordinator at 408.223.6713 or HR.Benefits@sjeccd.edu.

Employees are no longer allowed to waive medical coverage for themselves (with the exception of those currently grandfathered in). All employees must at least enroll themselves in Kaiser or Anthem Blue Cross.  Failure to submit your preferred plan enrollment form within your first 30 days of employment/becoming eligible for coverage will result in you (alone) being enrolled in Kaiser Permanente only.  You will not have any other coverage (no dental, vision, life insurance, LTD coverage) and none of your eligible dependents will be enrolled in any district plan until there is a qualifying event or you enroll during a regular Open Enrollment period. 

Life Insurance Coverage for Adult Children

Beginning on their 21st birthday and each birth month after that until they turn 23, adult children must be a full-time student at an accredited institution to remain covered by the District's life insurance policy. Before the last day of their birth month, a copy of their current class schedule indicating their total units, or a letter from the school stating their full-time status, and the form below must be submitted to the Human Resources Department or their life insurance coverage will end.

Student Certification Form 

Disabled Children

If you have an adult child who is disabled, temporarily or permanently, please contact the Benefits staff in Human Resources at extension 6713 to discuss available options of keeping him/her covered UNDER ALL PLANS regardless of age and/or student status. Adult children who become disabled after age 26 and become dependent on you may be eligible for enrollment under the District's health and welfare plans. Please contact HR.Benefits@sjeccd.edu or call 408.223.6713 immediately for more information and required documentation.

Keep Your beneficiaries Up to Date

• Update your beneficiary(s) for your District paid and/or supplemental life insurance (contact HR.Benefits@sjeccd.edu for supplemental coverage);
• Update your PERS or STRS beneficiary;
• Update your legal name (if you have legally changed it with Social Security)
• Update your home address or telephone number (if you have moved or changed your number recently)
• Update your Emergency Contact information
• Pre-Designate your personal physician to treat you for work related injuries/illnesses

Please note: due to the number of District employees, we are unable to verify the current emergency contact and/or the beneficiary(s) you have on file. If any time during the year you are unsure of who/what you listed, complete a new form(s) and submit the original(s) to Human Resources. All forms above are available all year long on this page and the Human Resources page.

Flexible Spending Accounts:

Flexible Spending Account Enrollment/Change Form

Medical Care Reimbursement Account  The 2024 annual medical care account maximum is $3,200.00 (the annual minimum is $240.00). You will automatically rollover of up to $610.00 of unused 2024 contributions to be available for you to use in 2025 (even if you do not open an account for 2025). Medical Care Reimbursement Account Flyer

Dependent Care Reimbursement Account The annual maximum for 2024 remains at $5,000.00 This plan allows you to accumulate pre-tax dollars to reimburse yourself for childcare expenses, and/or day care expenses for a disabled dependent while you are employed. Among the eligible expenses are after-school care or extended day programs, babysitters, elder care expenses (if elder is your dependent), preschool and summer day camp.  There is no rollover option for dependent care accounts.  Dependent Care Reimbursement Account Flyer

Transportation Account  The maximum MONTHLY election allowed is $315.00 This plan allows you to set pre-taxed dollars aside reimbursement of certain transportation expenses incurred as a direct result of your employment.  If you take public transportation (CalTrain, Bart, VTA, etc.).  Transit Plan Overview Flyer

For more information about Flexible Spending Accounts including forms for additional cards, automatic deposit, and the Orthodontia Treatment Statement are available by scrolling down on this page to the Flexible Spending Account section. IT IS THE PARTICIPANT'S RESPONSIBILITY TO ASSURE THE EXPENSES THEY USE THE PLAN FOR ARE ELIGIBLE EXPENSES AS EACH PLAN HAS STRICT LIMITATIONS ON WHEN ONE CAN CANCEL THE PLAN MID-YEAR.  iGOE Orthodontia Treatment Statement - Required if the Medical Care Reimbursement Account will be used for orthodontia services for you and/or a dependent Form for Additional Card (for spouse) iGOE Direct Deposit Form Setting up your Website and iGOE App Account Optional Forms (see below): Medical Care Worksheet (Broken link) Dependent Care Worksheet (Broken link)

Retirement accounts (403B & 457 plans)

Please refer to Payroll's Public Folder in Outlook for the required forms to enroll in or make changes to a 457 Deferred Compensation Account and for inquires to 403b accounts.

All permanent employees, full and part-time, and adjunct faculty are eligible to enroll in either plan. It does not matter whether you are currently a member of PERS or STRS. It also does not matter what union or constituency group to which you belong.

Plans available to you through your employment with the District (if eligible) are with one of the carriers below:

• CalPERS 457 Plan
• TIAA CREF
• Valic

ALL ENROLLMENT FORMS ARE AVAILABLE THROUGH THE PAYROLL DEPARTMENT, PLEASE CALL THEM AT (408) 270-6412 OR GO TO THEIR PUBLIC FOLDER IN OUTLOOK.

Pension Plans: CalPERS & CALSTRS

CalPERS:	CALSTRS:
PERS Address Change Form (Complete and Mail to PERS)	STRS Address Change Form (Complete and Mail to STRS)
PERS Website	STRS Website
PERS Beneficiary Designation Form	STRS Forms including Beneficiary Designation

Life Insurance & Long Term Disability

The Hartford:

Long Term Disability Insurance	Life Insurance
Academic Managers & Full-Time Faculty Classified Managers, Supervisors & Confidential Employees CSEA Unit Members	Basic Life Insurance & Accidental Death and Dismemberment (All) Hartford Beneficiary Form Supplemental Life Insurance Summary (Please contact HR.Benefits@sjeccd.edu to request an enrollment form) Estate Planning Assistance Travel Assistance and Identity Theft Addition Benefits/Resources from Hartford

To view the PowerPoint presentation on beneficiary designations, purchasing additional life insurance to and other benefits/services The Hartford provides eligible employees (from presentations held onsite April 14, 2015) please click the link below:

Supplemental Life Insurance Workshop, April 2015 (Broken link)

Claim Forms

VSP Out-of-Network Claim Form (Broken link)

iGOE Flexible Benefit Plan Reimbursement Request Form (Broken link)

Summary of Benefits and Coverage (SBC's)

Anthem Blue Cross

• For Active Enrollees including COBRA (group numbers 40911A, 409112A, 409113A)
• For Early Retirees <65 years old (group numbers 40911J, 40911K)

Kaiser Permanente

• Regular Active Employees including Adjunct Faculty (groups: #606394-0030ACN (Faculty), 606394-0030ALN (CSEA), and 606394-0030AMN (MSC)
• Associate Faculty DHMO Plan B (group #606394-0134ACN (part-time faculty only)
• Early Retirees <65 years old (group #60634-0029RBN, and 606394-0029ROR 

Delta Dental

• For All Enrollees (Active & Retired)

Summaries are not available for medical plans tied to Medicare

Medicare

If you are an employee currently enrolled in the District's Kaiser Permanente or Anthem Blue Cross Plan and you are nearing your 65th birthday, please see the pamphlet below provided by Medicare to learn about the steps you should take to enroll in Medicare Parts A&B (and possibly D) and when.

The District recommends you (and/or your spouse) enroll in Part A upon turning 65 - it's free - but you are not required to enroll in Medicare Part B (or D) in order to continue your medical coverage as an active employee with SJECCD. However, if you have other medical coverage you should reach out to that employer to assure compliance with their plan(s).

The District's plan will remain your primary while actively employed, therefore, we do not require you to sign up and pay for Part B (or D) upon your 65th birthday. You should take steps with Medicare to assure Parts B & D (and A if not already enrolled) are effective the first of the month after your employment/coverage ends with SJECCD.

Please see the Medicare Brochures below:

Applying Online for Medicare - Even if you Are Not Ready to Retire 2017

Medicare and You 2017