
2017-18 Open Enrollment - Active Employees
2017-18 Active Plan Comparison
Active Employees
Active Employee Plan Comparison
SISC III Change Form (dependents, addresses, etc)
Health Plan Election Form (Classified/Management)
Health Plan Election Form (Faculty/Certificated)
If you are changing from Blue Shield to Kaiser, also complete:
If you are changing from Kaiser to Blue Shield, also complete:
POP Form (Required for Buy-Up Plans)
Life Insurance Beneficiary Change Form
Voluntary Life Enrollment Form and Voluntary Rate Sheet
General Health Plan Information
Blue Shield 80-G Plan Information
Blue Shield 80-C Plan Information
Blue Shield 90-G Plan Information
Blue Shield 100-D Plan Information