Stacey Shoff
Benefits Coordinator
805.306.4500 Ext. 4015
Stacey.Shoff@
simivalleyusd.org
Delta Dental Plan OverviewDelta Dental Enrollment FormVision Full Coverage Benefits OverviewVSP - Kaiser Members (Materials Only Coverage) VSP Enrollment FormEmployee Assistance Program Mobile Access (ACI) Employee Assistance Program Referral ServicesEmployee Assistance Program Childcare EAP Education
2021 457b SRATo submit your 457b SRA online (recommended): https://tdsplans.org/form_SAA.aspx?plan=457&org=5898American FidelityReliance Standard Voluntary Life InsuranceReliance Voluntary Life Premium Table Reliance Standard Vol. Life Enrollment Application2020-2021 The Standard (for Non-Management Certificated Staff only)
BENEFITS
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:
www.calpers.ca.gov/page/education-center/using-mycalpers
healthcare online resources
RATES & FORMS
2021 Full Time Employee Monthly Contribution RatesCalPERS Health Plan ComparisonCalPERS Enrollment Health Program GuideAffidavit 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
