Stacey Shoff
Benefits Coordinator
805.306.4500 Ext. 4015
Stacey.Shoff@
simivalleyusd.org
DENTAL
VISION
EMPLOYEE ASSISTANCE PROGRAM
Delta Dental Plan OverviewDelta Dental Enrollment FormVision Full Coverage Benefits OverviewVSP - Kaiser Members (Materials Only Coverage) VSP Enrollment Form
Employee Assistance Program Mobile Access (ACI)
Employee Assistance Program Referral Services
MANDATED NOTICES
BENEFITS
This year’s Open Enrollment starts September 21 and ends October 16. Changes made during Open Enrollment will take effect January 1, 2021.
If you wish to make no changes to your health, dental or vision plans, there is no action required. However, if you are making any changes, all change requests must be completed and turned in to Benefits no later than October 16, 2020.
*Please note Blue Shield Trio HMO plan will be available in select areas of Ventura County in 2021 to full-time SVUSD staff at no cost. This plan offers employees who prefer HMO plans a smarter, more modern way to access health care. From better coordination among doctors and hospital to anytime, anywhere virtual care, it is a health plan that keeps up with your lifestyle. To enroll in Blue Shield Trio HMO, you must live or work in the Trio Zip Code service area.
Important Forms:
- To change your medical plan: 2021 CalPERS (HBD-12) Health Benefits Plan Enrollment Form for Active Employees
- To add or remove your spouse/domestic partner: Spouse verification form 2020
- For dental: Delta Dental Enrollment Form & Delta (SISC) Enrollment Change Form
- For vision: VSP Enrollment Form
- To update your designated beneficiary ($10,000 group term-life insurance): Reliance Standard Beneficiary
Important Plan Documents:
2021 CalPERS Health Benefit Summary
2021 PERS Choice 80/20 PPO Evidence of Coverage
2021 PERS Select 80/20 PPO Evidence of Coverage
2021 PERS CARE 90/10 PPO Evidence of Coverage
2021 Anthem Select HMO Evidence of Coverage
2021 Anthem Traditional HMO Evidence of Coverage
2021 Blue Shield Trio Evidence of Coverage & 2021 Blue Shield Trio Summary of Benefits
2021 Blue Shield Trio HMO Network Zip Code List & Blue Shield Trio 2021 Network List
2021 Blue Shield Access+ HMO Evidence of Coverage & 2021 Blue Shield Access+HMO Summary of Benefits
2021 Kaiser Evidence of Coverage & 2021 Kaiser Summary of Benefits
2021 United Healthcare HMO Evidence of Coverage & 2021 United Healthcare Summary of Benefits
How to register for myCALPERS to locate your current physician’s network in other plans for 2021: https://www.calpers.ca.gov/page/education-center/using-mycalpers
2020 plan documents
2021 Virtual Open Enrollment Presentations
2021 Full Time Employee Monthly Contribution Rates
2020 Full Time Employee Monthly Contribution RatesCalPERS Health Plan ComparisonCalPERS Enrollment Form HBD12Affidavit of Marriage/Domestic PartnershipSpouse/Domestic Partner Medical Coverage VerificationQuestionnaire for Disabled Dependent BenefitMedical Report for Disabled Dependent BenefitAffidavit of Parent-Child RelationshipMonthly Employee Premium Contributions Pre-tax ElectionReliance Standard BeneficiaryReliance Standard Group LifeReliance Standard EAP
Part-Time Employees
2021 Part Time Employee Contribution for All Tiers
2020 Rate Comparison for Part-Time Employee Only2020 Rate Comparison for Part-Time Employee + One Child2020 Rate Comparison for Part-Time Employee + Multiple Children OR Spouse2020 Rate Comparison for Part-Time Employee + One Child AND Spouse2020 Rate Comparison for Part-Time Employee + Multiple Children AND Spouse (Family)
