Current Benefits for Active Employees
Dental and Vision Audit Form 2020 (March 1, 2020 through May 31, 2020)
Dental and Vision Audit Letter
DENTAL, VISION & MEDICAL
Important Benefit Contact Information
Eligibility Rules for Dental, Vision and Medical Plans
DENTAL BENEFITS
Delta Dental Evidence of Coverage Booklet
Dental & Vision - Change in Enrollment
Delta Dental - Keep Smiling and Benefit Coverage Information
Delta Dental App - Stay Connected
Delta Dentist Estimate your Costs
Delta PPO Dentist Information Flyer
Delta Dental - Hearing and LASIK information
Delta Dental Amplifon Hearing Heath Care
Delta Dental QaulSight LASIK Services
VISION BENEFITS
Vision Service Plan (VSP) Evidence of Coverage Booklet
Eyewear Protection Program Flyer
VSP Out-of-Network Reimbursement Directions
VSP Out-Of-Network Reimbursement Form
MEDICAL BENEFITS
Medical Enrollment or Changes - CalPERS HBD-12 Form
Pre-Tax Election & Waiver Form for Medical Insurance Premium Payroll Deduction
Cash-In-Lieu of Medical Benefits
2020 CalPERS Health Benefit Summary Booklet
Summary of Benefits and Coverage Notice
Glossary of Health Coverage and Medical Terms
2020 Summary of Benefits and Coverage
OptumRx Pharmacy Benefits Information
OptumRX Pharmacy Frequently Asked Questions
- Anthem Select HMO
- Anthem Traditional HMO
- Blue Shield HMO
- Blue Shield Trio HMO
- Health Net Smart Care HMO
- Kaiser HMO
- United Healthcare HMO
- Western Health HMO
- Blue Cross PERS Care PPO
- Blue Cross PERS Choice PPO
- Blue Cross PERS Select PPO
2019-20 MEDICAL PLAN RATE SHEETS
2020 NEW MEDICAL ENROLLMENT
- JANUARY 1, 2020 START DATE
- FEBRUARY 1, 2020 START DATE
- MARCH 1, 2020 START DATE
- APRIL 1, 2020 START DATE
- MAY 1, 2020 START DATE
SELF PAY (Unpaid Leave)
Self Pay Medical, Dental and Vision Rate Sheet (If on Unpaid Leave)
Self-Pay Agreement Dental & Vision (Unpaid Leave)
Self-Pay Agreement Medical CalPERS (Unpaid Leave)
OTHER
John Muir Behavioral Health Center, Outpatient Services
In-Shape Health Club Membership Flyer
Discovery Transportation Benefits
