Health Benefits

Open Enrollment

Open Enrollment is the only time during the year you have the opportunity to change the medical, dental, and vision plans you are currently enrolled in.  Open Enrollment takes place June 1st through August 24th  each year.  Changes made take effect October 1st. If you are going to have any changes in your family in the upcoming plan year, Open Enrollment is the time to determine if your plan still meets your needs.

Open Enrollment forms are due to your district/charter school office no later than August 24, 2018 for the 2018-2019 plan year.

***2018-19 Open Enrollment Presentation***

Enrollment Forms, Annual Notices, and Information 

Anthem Enrollment Form        2018-19 Annual Health Benefit Notices                   

2018-19 Plan Comparison

Kaiser Enrollment Form   HIPPA Notice of Privacy   Dependent Eligibility Requirements  
Declination of Coverage-Less than FT    Declination of Coverage-Full Time   Qualifying Events
    Membership Change      

2018-2019 Health Benefit Renewal Information Packet

If you are an employee that would like to keep your current plan and make no changes, please complete your site specific plan election form:

  • Enrollment Health Plan Election Form- (Site Specific)

If you are an employee that would like to enroll in a new plan,  please complete the enrollment health plan election for your site and  one of the enrollment forms below.  

  • Insurance Carrier's Enrollment- Anthem or Kaiser enrollment form 

If you are an employee that needs to change your dependents please complete the enrollment health plan election for and the membership change form below:

  • Membership Change form-to add/delete dependents 

If you are an employee that would like to decline coverage please complete one of the declination of coverage forms below:

  • Declination of Coverage- less than full time and full time employees  

***The 2018-2019 plan descriptions will be provided as soon as they become available***

Below are the 2017-2018 health benefit plan descriptions (SBC's)

Anthem PPO 100% Plan SBC 10/1/17 thru 9/30/18

Anthem PPO 90% Plan SBC 10/1/17 thru 9/30/18

Anthem PPO 80%-G Plan SBC 10/1/17 thru 9/30/18

Anthem PPO 80%-L Plan SBC 10/1/17 thru 9/30/18

Anthem PPO Minimum Value Plan SBC

Anthem PPO 2-Tier Anchor Bronze Plan SBC 10/1/17 thru 9/30/18

Kaiser $10 Co-Pay Plan SBC 10/1/17 thru 9/30/18

When you enroll in one of the above medical plans (excluding the Anthem PPO 2-Tier Anchor Bronze Plan), you are automatically enrolled in the following Vision and Dental plans.

VSP Vision Dual Co-Pay - Plan B
Delta Dental Incentive Plan

Use the Contact Benefits list and contact the carrier if you have questions about a plan’s drug coverage or to see if your medication is covered.

Annual Health Benefit Notices

2018-19 Annual Health Benefit Notice

2017 -18 Annual Health Benefit Notice 


Optional Benefits

Our Member Districts and Charters allow eligible employees to particiapte in several optional benefit programs.   Prior to submitting enrollment forms, please verify with your District or Charter that you are eligible to participate.  

Flexible Spending Account

A Flexible Spending Account (FSA) lets you set aside money from your paycheck on a pretax basis to use for eligible out-of-pocket expenses.  We offer FSA's through SISC.

 There are three types of FSAs.

Health Care FSA – You can use this account to pay for eligible medical, dental, vision, hearing and prescription drug expenses for you, your spouse and your eligible tax dependents. 
Dependent Care FSA – You can use this account to pay for eligible child and adult care expenses like day care, before and after school care, nursery school, preschool, and summer day camp.  
Limited Purpose FSA – You can generally use this account to pay for eligible dental and vision expenses. Eligible expenses may also include prescriptions, over-the-counter items and other health expenses based on your plan. You can enroll in this account, if you have a Health Savings Account (HSA)

SISC Flex Enrollment Guide  SISC Flex Enrollment Form SISC FLEX POP Enrollment Form  SISC Flex Website

403 (b) and 457(b) Plan

Public schools, colleges, universities, charities, state governments, local governments and other tax-exempt entities under section 501(c)(3) of the IRS code are able to offer 403(b) plans.  The 403(b) is a strictly voluntary program wherein employees can contribute money to a retirement savings account that functions almost exactly like a 401(k): an employee makes a pre-tax contribution in the form of a payroll deduction, and that money grows tax-deferred until retirement. 

If you would like to start contributiing to a a 403(b) plan, please contact contact a fiancnial Adviosr to have one set up.   After your account has been setup the Payroll Department will need forms completed to authorize payroll deductions.

403(b) Salary Reduction Authorization  457(b) Deferred Services Form

Links to Salary Amendment Agreements for  403(b) and 457 (b) plans 

   ACE Charter  BRIDGES Charter School  

Briggs School District  Medows Arts & Technology Elem. School  

Mesa Union School District  Mupu Elementary School District  

River Oaks Academy Charter School  Santa Clara Elementary School District 

   Somis Union School District  Ventura Charter School  Ventura County Schools BSA