Previous Plan Year 2022 - December 31, 2022

• Peralta CCD MHN EAP Benefit Summary
• EAP Overview
• EAP – Evidence of Coverage
• Child and Eldercare
• Daily Living Services
• Financial Services
• ID Theft
• Wellness Coaching – Our Aware Program
• Wellness Coaching – Personalized
• Legal Services
• Employee Assistance Program (EAP) – Managed Health Network 2022 Open Enrollment Presentation

• Peralta Self Funded Traditional PPO SBC $15 Plan (Local 39)
• Peralta Self Funded Traditional PPO SBC $15 Plan (Local 1021 & Confidential)
• Peralta Self Funded Traditional PPO SBC $10 Plan (PFT, Management & Trustees)
• Peralta Self Funded Lite PPO SBC $15 Plan (Local 39)
• Peralta Self Funded Lite PPO SBC $15 Plan (Local 1021 & Confidential)
• Peralta Self Funded Lite PPO SBC $10 Plan (PFT, Management & Trustees)
• Registering on myTrustmarkBenefits.com
• Understanding your Explanation of Benefits  (EOB)
• Download the myTrustmarkBenefits Mobile App
• Stay connected with myTruskmarkBenefits Wire
• PHM My Health Center
• PHM Health Assessment Flyer
• PHM Digital Coaching
• PHM Mobile App
• LiveHealthOnline Flyer How to Register
• Using LiveHealth Online
• Convenient care during COVID-19
• Active&Fit DIRECT – Member FAQs
• Trustmark 2022 Open Enrollment Presentation
• Trustmark – Anthem PPO Active Employees 2022 Open Enrollment Presentation
• Trustmark – Anthem PPO Retirees 2022 Open Enrollment Presentation

• Active and Post-July 1, 2012 Retirees Employee Benefit Plan Document and Summary Plan Description

• Post-July 2004 Retiree Benefit Plan Document and Summary Plan Description

• Pre-July 2004 Retiree Benefit Plan Document and Summary Plan Description

• Amendment #1 For Pre-July 2004 Retiree Benefit Plan

• Amendment #2 For Pre-July 2004 Retiree Benefit Plan

• Peralta-Community-College-Kaiser-HMO-0 SBC
• Peralta-Community-College-Kaiser-HMO-0 Principal benefits for Kaiser Permanente Traditional HMO Plan
• Peralta-Community-College-Kaiser-HMO-10  SBC
• Peralta-Community-College-Kaiser-HMO-10 Principal benefits for Kaiser Permanente Traditional HMO Plan
• Peralta-Community-College-Kaiser-HMO-15 SBC
• Peralta-Community-College-Kaiser-HMO-15 Principal benefits for Kaiser Permanente Traditional HMO Plan
• Healthy Resource Guide
• Mental Health and Wellness Brochure NCAL
• Caring for the whole you
• KP App Flyer
• Active fit flyer
• myStrength Flyer National
• MinuteClinic Traveling Members Infographic
• KP Wellness Coaching by Phone
• KP ClassPass Promotional Flyer
• KP Choose Healthy Complementary Care
• KP Accessing Telehealth
• KP Calm Promotional Flyer
• Kaiser HMO Active Employees 2022 Open Enrollment Presentation

Universal Benefit Enrollment Form – Retiree & Exceptional Processing

Universal Benefit Enrollment Form – Retiree & Exceptional Processing

*Active Employees must make changes via BenefitBridge

*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 EOC HMO $0
• KAISER EOC HMO $10
• KAISER EOC HMO $15

• 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
• Delta Dental-Medicare HMO-Plan Summary_CM_CA_EN for Kaiser SR ADV
• Kaiser Permanente Senior Advantage (HMO) Enrollment Form
• Healthy Resource Guide
• Mental Health and Wellness Brochure NCAL
• Caring for the whole you
• KP App Flier
• Active fit flyer
• myStrength Flyer National
• MinuteClinic Traveling Members Infographic
• KP Wellness Coaching by Phone
• KP ClassPass Promotional Flyer
• KP Choose Healthy Complementary Care
• KP Accessing Telehealth
• Kaiser Sr. Advantage Plans – Retirees 2022 Open Enrollment Presentation
• KP Calm Promotional Flyer

Universal Benefit Enrollment Form – Retiree & Exceptional Processing

Universal Benefit Enrollment Form – Retiree & Exceptional Processing

*Active Employees must make changes via BenefitBridge

*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 EOC KPSA $0
• KAISER EOC KPSA $10
• KAISER EOC KPSA $15

Kaiser Reimbursement Form

Kaiser Vision Plan & UHC Vision Plans – Benefits Summary

• 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
• Use your UHC vision benefits at Warby Parker
• UHC DENTAL & VISION 2022 Open Enrollment Presentation

• UHC Dental DHMO – Welcome brochure
• UHC Dental Select Managed Care CA Open Enrollment Brochure
• Summary of Dental Benefits and Coverage Disclosure Matrix (SDBC)
• UHC DHMO – Direct Compensation Dental Plan Evidence of Coverage
• UHC Dental DHMO – Direct Compensation (DC) Contributory CA250/covered dental services CA D1065
• UHC Dental Vision Discount Flyer
• UHC DENTAL & VISION 2022 Open Enrollment Presentation

• Delta Dental PPO Plan – Plan Summary
• Delta PPO Plan – Evidence Of Coverage (EOC)
• Find a Network Dentist
• Estimate Your Costs
• Pre-treatment Estimate
• Meet your new value-added features
• Delta Dental PPO 2022 Open Enrollment Presentation
  • Password: PCCDDELTA

• VSP Vision Benefits Summary
• Exclusive Member Extras
• Save Time and Money with Eyeconic
• Primary EyeCare – PEC – Program
• See Well. Be Well.
• Sign-in Save More
• TruHearing Hearing Aid Discount Offer

• Group Basic Life Insurance Plan
• Group Disability Insurance Plan
• Voya Group Life, Disability & Supplemental Life Insurance Presentation

• Group Supplemental Life Insurance Plan
• Group Supplemental Life Insurance Plan Rates - Effective 7-1-2022
• Evidence of Insurability Form Instructions
• Evidence of Insurability (EOI) Form
• Voya Group Life, Disability & Supplemental Life Insurance Presentation

*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 – Transition Guide
• CBIZ FSA Handbook
• CBIZ FSA Enrollment Form

Flexible Spending SPD: 2014-spd-003

• CBIZ FSA Claim-form
• 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: 1-800-815-3023, Option 4

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 Pre-Tax Commuter Handbook
• CBIZ Pre-Tax Commuter Enrollment Form

Pre-Tax Commuter SPD: peralta-132-doc

*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: 1-800-815-3023, Option 4

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.

CBIZ Online Registration

 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
• Medicare Reimbursement Plan Policy Statement 10.2015
• CBIZ Direct-deposit-authorization