Plan Year July 1, 2021 – June 30, 2022
Important links
- 2021-2022 PCCD Employee Benefits Guide with Monthly Contribution Rate Matrix
- Open Enrollment 2021-2022 Virtual Presentations, Videos & Materials
- Registration and login online instructions for BenefitBridge
- BenefitBridge Secure Enrollment Portal
- PCCD Required Documentation Matrix
- 403 (b) & 457 (b) Plan Information
- Voluntary Benefits
Medical plans
Kaiser HMO Plans
- 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
- Kaiser Permanente Senior Advantage (HMO) Enrollment Form
Click here for additional information
Universal Benefit Enrollment Form – Retiree & Exceptional Processing
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.
Anthem PPO Traditional & PPO Lite
Self-funded Plans Administered by Trustmark
- 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)
Click here for additional information
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 uploaded the completed form with all required insurance verifications during your BenefitBridge online enrollment.
Dental / Vision / District-paid insurance
District-Paid Life Insurance
District-Paid Disability Insurance
Additional Documents
*Open enrollment occurs annually November 1-30 for the following plan year (January – December).
CBIZ Open Enrollment 2021 Presentation
Current year forms & Documents:
CBIZ FSA Handbook
CBIZ FSA Enrollment Form
Flexible Spending SPD: 2014-spd-003
CBIZ Direct-deposit-authorization
CBIZ FSA Change in Status or Termination Form
My Plans by CBIZ Direct Deposit Instructions
CBIZ CONTACT INFORMATION
EMAIL: cbizflex@cbiz.com
TELEPHONE: 1-925-956-0514
CBIZ Open Enrollment 2021 Presentation
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 $280/month
Transportation Expenses $280/month (Public transportation/vanpool)
CBIZ COMMUTER – Transition Guide
CBIZ Pre-Tax Commuter Handbook
CBIZ Pre-Tax Commuter Enrollment Form
Pre-Tax Commuter SPD: peralta-132-doc
CBIZ PRE-TAX COMMUTER (PARKING ONLY) Claim-form
*CBIZ debit card must be used for eligible transit expenses starting 1/1/2021.
CBIZ Direct-deposit-authorization
My Plans by CBIZ Direct Deposit Instructions
CBIZ CONTACT INFORMATION
EMAIL: cbizflex@cbiz.com
TELEPHONE: 1-925-956-0514
Medicare Reimbursement Direct Deposit
If you are currently receiving direct deposits from CBIZ for your Medicare Premium Reimbursements and are not registered online on the CBIZ platform, click on the link below. Once registered you will be able to manage your direct deposit information.
If you are already registered on the CBIZ platform and would like to update your direct deposit information you can click on the link below.
https://myplans.cbiz.com/
My Plans by CBIZ Direct Deposit Instructions
Medicare Downloads
Medicare A, B & D Premium Reimbursement Plan Summary Plan Description (SPD) 2015
Medicare-A-and-B-and-D-Premium-Claim-Form-Revised-11-24-21
