This site has detected that you are currently browsing using Internet Explorer 8. The Yosemite Community College District website makes use of several modern web and mobile technologies that are not compatible with versions of Microsoft Internet Explorer earlier than IE 9. This incompatibility will prevent the website from displaying properly on your computer. We recommend viewing this website using a more modern web browser. This site has been tested for compatibility with all web browsers released after 2010. For assistance viewing this website, please contact the YCCD IT Service Desk at 209-575-7900

Skip to main navigation, which will allow you to navigate to a different content area. Skip to side navigation, with links to other pages from the same office you are currently viewing. Skip to the content on this page. Skip to top navigation, with office and website directories, maps, and content information. Skip to the website search box. Skip to the links at the bottom of the page, including commonly accessed links and employee resources.


View Section Menu



If you are retiring from your active position, below are all the forms you will need:

New Retiree Election Form

2023-24 Retiree Monthly Premium Rate Sheet (effective 10/01/2023)

2023-24 Plan Comparison - Retirees UNDER 65   

2023-24 Plan Comparison - Retirees OVER 65 or w/Medicare AB

 -   Blue Shield Enrollment Form (if changing from Kaiser to Blue Shield)

 -   Blue Shield 65+ EGWP or COMPANION CARE Form (REQUIRED if BOTH parties are over 65 and/or         have Medicare AB)


  -    Kaiser Enrollment Form (if changing from Blue Shield to Kaiser)

 -    Kaiser Permanente Senior Advantage (KPSA) Enrollment Form For any Kaiser members over 65              &/or with Medicare AB.  IMPORTANT! Return enrollment form and copy of Medicare Card to                    BENEFITS! Do not send directly to Kaiser!!       


Retiree Verification of Contact Information Form

All About Your Retiree Benefits

Setting Up Bill-Pay Instructions

Address Change Form - Change mailing or legal address. Supplemental documentation may be required.

SISC III Change Form - Name change or add/drop dependents - contact Benefits for regulations and requirements



Some forms are in the interactive PDF format. If further assistance is required, please contact the Benefits Office at (209) 575-6547.

NOTE:  General Retiree Forms are at the BOTTOM of this page

Address Change Form - Change mailing or legal address. Supplemental documentation may be required.

SISC III Change Form - Name change or add/drop dependents; contact Benefits for regulations and requirements.


General Information:




Retirees Over 65 - Blue Cross CompanionCare Option:

Click HERE for link to more information.


For RETIREES BEYOND DISTRICT CONTRIBUTION - turning 65/70 and no longer eligible for District-paid Medical Plans:

You may CONTINUE your health insurance through the District if you pay the full premium.  For information on the new Blue Shield CompanionCare option, click here.

2023-2024 Retiree Monthly Premium Rate Sheet - Rates effective 10/01/2023

If you wish to CHANGE your health plan upon your retirement, please complete the New Retiree Election Form.  Otherwise, changes can only be made at Open Enrollment.

Exception:  You may switch to Blue Shield CompanionCare at any time with a 45-60 day notice.  If you make this switch, you can only switch back to a District Plan at Open Enrollment.



Remember that any premiums are due by the 1st of every month.  Checks should be made payable to: YCCD and mailed to YCCD, Attn: Fiscal Services, PO Box 4065, Modesto, CA  95352.  Please write "Retiree Benefits" and the month for which you are paying in the memo line of your check.

Although we do not have the ability for you to pay online, here are the instructions for setting up automatic bill pay with your financial institution:  Bill Pay Instructions



Navitus Pharmacy Benefit Information



2023-2024 NEW RETIREE Election Form

Blue Shield PPO Enrollment Form

Blue Shield PPO EGWP (over 65 w/Medicare A & B)

Blue Shield CompanionCare Enrollment (over age 65/70)

Kaiser Enrollment Form (Retirees Under Age 65)

Kaiser Senior Advantage Form (KPSA) (Retirees Over age 65 &/or with Medicare A & B)

Address Change Form (Change mailing or legal address. Supplemental documentation may be required.)

SISC III Change Form (Name change or add/drop dependents - contact Benefits for regulations and requirements.)

Blue Shield Claim Form

Prescription Claim Form



Note: The following form is due in the Benefits Office by the 15th of the month prior to the termination month.  Account must be current at the time of request.

Request for Termination of Benefits


Website & Contact Information:

Blue Shield PPO
Member Services: 1-800-393-6130
Member Services: 1-866-333-2757
BIN#: 610602
RXGroup#: RX4S ISC
Member Services: 1-800-464-4000