NEW RETIREE Benefits:
If you are retiring from your active position, below are all the forms you will need:
2022-23 Retiree Monthly Premium Rate Sheet (effective 10/01/2022)
2022-23 Plan Comparison - Retirees UNDER 65
2022-23 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)
EXAMPLE: COMPLETED BLUE SHIELD EGWP/COMPANION CARE FORM
- 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
CURRENT RETIREE FORMS:
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.
2022-2023 Retiree Monthly Premium Rate Sheet - Rates effective 10/01/2022
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.
MAKING PAYMENTS:
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
PHARMACY:
Navitus Pharmacy Benefit Information
ALL FORMS:
2022-2023 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.)
TO END ANY/ALL BENEFITS:
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
