Benefits Archive

• Peralta-Community-College-Kaiser-HMO-10 SBC 
• Peralta-Community-College-Kaiser-HMO-15 SBC 
• Peralta-Community-College-Kaiser-HMO-  0 SBC 

• Peralta Community College 65 HMO $0 SR ADV Benefit Summary
• Peralta Community College 65 HMO $10 SR ADV Benefit Summary
• Peralta Community College 65 HMO $15 SR ADV Benefit Summary

Universal Benefit Enrollment Form – Retiree & Exceptional Processing

*Retirees enrolling in a Kaiser Permanente Senior Advantage Plan must complete the Kaiser Permanente Senior Advantage Enrollment form (above) and mail to the address on the form. If you are changing your medical plan during open enrollment also complete the Universal Benefit Enrollment Form (above) and mail to the PCCD Benefits Office at the address on the form along with any required dependent documents if applicable. Remember to enclose a copy of the Kaiser Permanente Senior Advantage Form mailed directly to Kaiser

• Kaiser Reimbursement Form
• Kaiser Permanente Senior Advantage (HMO) Enrollment Form

• Peralta Self Funded Traditional PPO SBC $15 Plan (Local 1021 & Confidentials
• Peralta Self Funded Traditional PPO SBC $10 Plan (PFT, Management & Trustees)
• Peralta Self Funded Traditional PPO SBC $15 Plan (Local 39)
• Peralta Self Funded Lite PPO SBC $15 Plan (Local 1021 & Confidentials)
• Peralta Self Funded Lite PPO SBC $10 Plan (PFT, Management & Trustees)
• Peralta Self Funded Lite PPO SBC $15 Plan (Local 39)

Universal Benefit Enrollment Form – Retiree & Exceptional Processing

*Retirees changing medical plans during open enrollment must complete the Universal Benefit Enrollment Form (above) and mail to the PCCD Benefits Office at the address on the form along with any required dependent documents if applicable.

CASH IN-LIEU OF MEDICAL & DENTAL BENEFITS FORM

If you are an active employee waiving medical and dental benefits please upload the completed form with all required insurance verifications during your BenefitBridge online enrollment.

• Delta Dental PPO Plan – Plan Summary 

• UHC DHMO – Direct Compensation Dental Plan Evidence of Coverage
• UHC DHMO – Direct Compensation (DC) Contributory CA250/covered dental services CA D1065

• Kaiser Vision Plan & UHC Vision Plans – Benefits Summary

• VSP (Voluntary Vision) – Benefits Summary

District-Paid Disability Insurance

• Long Term Disability Certificat  

Employee Assistance Program (EAP)

• EAP Evidence of Coverage

*Open enrollment occurs annually November 1-30 for the following plan year (January – December).

Current year forms & Documents:

CBIZ FSA – Transition Guide

CBIZ FSA Handbook with Enrollment Form- 2021

Flexible Spending SPD: 2014-spd-003

PENSION DYNAMICS FSA Claim-form Plan Year 2020

CBIZ FSA Claim-form Plan Year 2021

CBIZ Direct-deposit-authorization

CBIZ FSA Change in Status or Termination Form

The maximum amount you may contribute to each account cannot exceed the maximum amount specified in Code Section 132(f).

The maximum amounts are:

Parking Expenses $270/month

Transportation Expenses $270/month (Public transportation/vanpool)

CBIZ COMMUTER – Transition Guide

CBIZ Pre-Tax Commuter Handbook with Enrollment Form – 2021

Pre-Tax Commuter SPD: peralta-132-doc

PENSION DYNAMICS Pre-Tax Commuter Claim Form (Eligible expenses prior to 12/31/2020

CBIZ PRE-TAX COMMUTER (PARKING ONLY) Claim-form Plan Year 2021

*CBIZ debit card must be used for eligible transit expenses effective 1/1/2021.

CBIZ Direct-deposit-authorization

Medicare A, B & D Premium Reimbursement Plan Summary Plan Description (SPD) 2015

Medicare-A-and-B-and-D-Premium-Claim-Form-Revised-11-24-20

Medicare Reimbursement Plan Policy Statement 10.2015

CBIZ Direct-deposit-authorization

Virtual Health Fair Meetings Schedule

Anthem PPO Traditional & Lite Self-Funded Medical Plans

*Administered by Trustmark

Anthem PPO Traditional & Lite Self-Funded Plans 2020-2021 Active Employee Open Enrollment Presentation (Administered by Trustmark)

Anthem PPO Traditional & Lite Self-Funded Plans 2020-2021 Retiree Open Enrollment Presentation (Administered by Trustmark)

Registering on myTrustmarkBenefits.com

LiveHealthOnline Flyer How to Register

Using LiveHealth Online

Understanding your Explanation of Benefits  (EOB)

Download the myTrustmarkBenefits Mobile App

Lifestyle Management Health Center

Lifestyle Management Overview

Stay connected with myTruskmarkBenefits Wire

Active&Fit DIRECT – Member FAQ’s

Kaiser Permanente Traditional HMO & Senior Advantage Medical Plans

Kaiser Permanente Traditional HMO Plans 2020-2021 Active Employees & Retirees without Medicare Coordination Presentation – Video link included

Kaiser Permanente Senior Advantage Plans 2020-2021 Retirees Age 65 & Over with Medicare Presentation – Video link included

Kaiser Permanente Senior Advantage Plans 2020-2021 Retirees Age 65 & Over with Medicare Presentation – Virtual Health Fair Video link included

•Delta Dental DHMO plan for Kaiser Senior Advantage members included in presentation

KP Mobile App Flier 2020

KP Accessing Telehealth

KP ChooseHealthy-ComplementaryCare 2020

KP Wellness-Coaching by Phone 2019

MinuteClinic Traveling Members

myStrength_Flyer_National

Voya District Paid Life & Disability Insurance

Peralta CCD – Voya Open Enrollment Recorded Virtual Meeting Presentation   Password is “2020PCCDoe”.

Voya District Paid Life, A D & D & Disability Insurance Presentation – Open Enrollment 2020-2021 

Everest Funeral Planning

Travel Assistance

UHC Vision Plans (Bundled with Anthem PPO Traditional & Lite Medical Plans)

UHC Vision – Welcome brochure

UHC Vision $ 15.00 copay plan bundled with Anthem PPO Traditional & Lite Medical Plans – L39

UHC Vision $ 10.00 copay plan bundled with Anthem PPO Traditional & Lite Medical Plans –  All groups except L39

UHC Vision Contact Formulary List – January 2020

Use your UHC vision benefits at Warby Parker

Your benefits could go further with Warby Parker

Delta Dental PPO Self-Funded Dental Plan

Delta Dental PPO Self-Funded Plan Benefits Overview Presentation – Active Employees

Find a Network Dentist

Estimate Your Costs

Pre-treatment Estimate

Meet your new value-added features

Delta Dental PPO AB-528 Dental Plan – Retiree Faculty

Delta Dental PPO AB-528 Plan Benefits Overview Presentation – Retired Faculty

*Offered to Faculty members at the time of retirement along with Dental COBRA continuation offer. Plan not available during retirement if not elected during the applicable offer period following retirement.

UHC Dental DHMO Plan

UHC Dental DHMO – Welcome brochure

UHC Dental Select Managed Care CA Open Enrollment Brochure

UHC DHMO – Direct Compensation Dental Plan Evidence of Coverage

UHC Dental DHMO – Direct Compensation (DC) Contributory CA250/covered dental services CA D1065

Cigna Voluntary Term Life Insurance

CIGNA Open Enrollment Recorded Virtual Meeting Presentation  Password:2020PCCDoe

VOLUNTARY TERM LIFE AND VOLUNTARY ACCIDENTAL DEATH AND DISMEMBERMENT (AD&D) INSURANCE SUMMARY (10/2017)

Cigna Life Insurance Change Form Application

VSP Voluntary Vision Plan

VSP Open Enrollment Recorded Virtual Meeting Presentation Password: 2020PCCDoe

VSP Vision Benefits Summary

Employee Assistance Program – MHN

MHN (EAP) Open Enrollment Recorded Virtual Meeting Presentation Password: 7t!t0n#?

Evidence of Coverage

Plan Year July 1, 2019 – June 30, 2020

2019-2020 PCCD Employee Benefits Guide with Rate Matrix

PCCD Required Documentation Matrix

Registration and login online instructions for BenefitBridge

BenefitBridge Secure Enrollment Portal

Kaiser Permanente Downloads

• Kaiser Reimbursement Form Revised 2018

2019-2020 Traditional Plan Summary of Benefits & Coverage

• Peralta-Community-College-Kaiser-HMO-10  SBC 

• Peralta-Community-College-Kaiser-HMO-15 SBC 

• Peralta-Community-College-Kaiser-HMO-0 SBC

2019-2020 Senior Advantage Summary of Benefits & Coverage

• Peralta Community College 65 HMO $0 SR ADV Benefit Summary

• Peralta Community College 65 HMO $10 SR ADV Benefit Summary

• Peralta Community College 65 HMO $15 SR ADV Benefit Summary

Self-funded Plan Downloads

2019-2020 Summary of Benefits & Coverage

• Peralta Self Funded Traditional PPO SBC $15 Plan (Local 1021 & Confidentials)

• Peralta Self Funded Traditional PPO SBC $10 Plan (PFT, Management & Trustees)

• Peralta Self Funded Traditional PPO SBC $15 Plan (Local 39)

• Peralta Self Funded Lite PPO SBC $15 Plan (Local 1021 & Confidentials)

• Peralta Self Funded Lite PPO SBC $10 Plan (PFT, Management & Trustees)

• Peralta Self Funded Lite PPO SBC $15 Plan (Local 39)

Dental

• Delta Dental PPO Plan – Plan Summary 

• UHC Dental – Direct Compensation DHMO Dental Plan Evidence of Coverage

Vision

• VSP (Voluntary Vision) – Benefits Summary

District-Paid Life Insurance

• Life Insurance Certificate

District-Paid Disability Insurance

• Long Term Disability Certificate

Employee Assistance Program (EAP)

• EAP Evidence of Coverage:  2019-eap-peraltacommunitycollege14eoc

• EAP Summary Benefit Comparison:  2016-mhn-eap-sbc

Flexible Spending Medical and Dependent Day Care Expenses under IRS Code 125

Current year forms & Documents:

• Handbook with Enrollment Form- 2020

• Flexible Spending SPD: 2014-spd-003

• Claim-form

• Direct-deposit-authorization

Pre-tax Commuter Expense under IRS Code 132

Contribution Limit Increase for 2020:

The maximum amount you may contribute to each account cannot exceed the maximum amount specified in Code Section 132(f).

The maximum amounts are:

1. Parking Expenses $270/month

2. Transportation Expenses $270/month (Public transportation/vanpool)

• Handbook with Enrollment Form – 2020

• Pre-Tax Commuter SPD: peralta-132-doc

• Direct-deposit-authorization

Medicare Downloads

• Medicare A, B & D Premium Reimbursement Plan Summary Plan Description (SPD) 2015

• Medicare-A-and-B-and-D-Premium-Claim-Form-Revised-11-24-20

• Medicare Reimbursement Plan Policy Statement 10.2015

2018-2019 PCCD Employee Benefits Guide with Rate Matrix click here

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2017-2018 PCCD Employee Benefits Guide

Kaiser Permanente Downloads

2018-2019 Traditional Plan Summary of Benefits & Coverage

• Peralta-Community-College-Kaiser-HMO-10  SBC 

• Peralta-Community-College-Kaiser-HMO-15 SBC 

• Peralta-Community-College-Kaiser-HMO-0 SBC

2018-2019 Senior Advantage Summary of Benefits & Coverage

• Peralta Community College 65 HMO $0 SR ADV Benefit Summary

• Peralta Community College 65 HMO $10 SR ADV Benefit Summary

• Peralta Community College 65 HMO $15 SR ADV Benefit Summary

Self-funded Plan Downloads

2018-2019 Summary of Benefits & Coverage

• Peralta Self Funded Traditional PPO SBC $15 Plan(Local 1021 & Confidentials)

• Peralta Self Funded Traditional PPO SBC $10 Plan (PFT, Management & Trustees)

• Peralta Self Funded Traditional PPO SBC $15 Plan(Local)

• Peralta Self Funded Lite PPO SBC $15 Plan(Local 1021 & Confidentials)

• Peralta Self Funded Lite PPO SBC $10 Plan (PFT, Management & Trustees)

• Peralta Self Funded Lite PPO SBC $15 Plan (Local 39)

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