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Archived Forms & Documents

Fall 2014 Part Time and Hourly Faculty Members Benefits Enrollment!!!
As a temporary or part-time faculty member you may be eligible for participation in the District’s medical, dental, flexible benefit plans enrollment based on your past part-time teaching load. Please download and print the following documents in PDF format which are required for enrollment/re-enrollment in the benefit plans.

  • Current coverage is due to end Sunday, August 31, 2014.
  • For continuous, uninterrupted coverage, enrollment is REQUIRED for all Part Time and Hourly Faculty employees by Tuesday, September 23, 2014.
  • New Enrollees – Enroll by Tuesday, September 23, 2014or within 30 days of loss of coverage under another plan.

Enrollment Downloads:

pdf_small.gifFall 2014 Part-Time & Hourly Faculty Open Enrollment Announcement
pdf_small.gif
Fall 2014 Part-Time & Hourly Faculty Open Enrollment Forms Packet

  • Benefits Enrollment Checklist
  • Part-Time & Hourly Faculty Enrollment Form
  • Eligibility Affidavit
  • Required Documentation Matrix
  • FAQ – Benefits & What to Expect After Enrollment

(ALL PAGES contained in this document MUST be completed and submitted to the District Benefits Office no later than Tuesday, September 23, 2014)

pdf_small.gif2014 Flexible Spending Accounts Enrollment Form
pdf_small.gif2014 Commuter/Parking Expense Plan Enrollment Packet

pdf_small.gif2014 Peralta/PFT Successor Agreement

  • Benefits Office Week of Events Schedule (4/22 – 4/24/2014)
  • Dependent Audit 2014 – Initial Mailing
  • Dependent Audit 2014 – Non-Response Letter
  • Dependent Audit 2014 – FAQs (1-15)
    • FAQ 16: I have received my dependent eligibility audit packet from CoreSource. Do I complete the audit even if my dependents and I are enrolled in Kaiser?
      • Answer: Yes.
    • FAQ 17: Once I have submitted my documents, how long will it take for the confirmation to be sent to me at my home address?
      • Answer: The documents are usually reviewed within 2-3 business days of receipt.  The employee/retiree is contacted via a letter mailed to the address on file at that time.  Contact Peralta’s dependent eligibility audt experts at CoreSource, our partner for his project. Send your inquiry
    • FAQ 18: I am enrolled in benefits, I have dependents who are also enrolled in Peralta benefits. I did not receive my packet or if I did, I lost it. What should I do to ensure that I meet the March 31, 2014 deadline?
      •  Answer: Contact Peralta’s dependent eligibility audit experts at CoreSource, our partner for his project no matter which Peralta plan on which you are enrolled.  Our partner issues the dependent verification packets, sends acknowledgements and folllows up.  Direct your inquiries as follows:
    • FAQ 19: Will I receive an update about the status of my documents?
      • Answer: Yes. Employees and retirees are updated throughout the audit processed.
          • Once documents are received and processed by CoreSource, then notification is sent to the home address.
          • If documents or a response was pending as of March 10, then reminder notifications were mailed from CoreSource to non-respondents.
  • April 2014 – June 2014 New Employee Benefits Orientation and Retirement Schedule (updated 3-27-2014)
  • February/March 2014 Peralta Benefits Everyone Newsletter
Peralta Healthy Community Schedule of Events (January & February 2014) 2/25/2014 Jennifer Seibert
Spring 2014 Part Time & Hourly Faculty Open Enrollment Announcement 2/25/2014 Jennifer Seibert
Spring 2014 Part Time & Hourly Faculty Open Enrollment Forms Packet 2/25/2014 Jennifer Seibert
Professional Day Activities January 15, 2014 / Schedule of Events 1/15/2014 Jennifer Seibert
Tax Deferred Planning – Complimentary Dinner Seminar (January 14 and 15, 2014) 1/14/2014 Jennifer Seibert
December 2013/January 2014 Peralta Benefits Everyone Newsletter 12/15/2013 Jennifer Seibert
Section 125 Medical Reimbursement “Use it or Lose it” Letter (mailed 11/12/2013) 11/12/2013 Jennifer Seibert
Peralta Benefits – Everyone  October 28, 2013 (mailed 10/28) 10/28/2013 Jennifer Seibert
Section 125 Flexible Benefit Plan Handbook 2014 10/28/2013 Jennifer Seibert
Annual Survey 9/5/2013 Jennifer Seibert
PERALTA BENEFITS – EVERYONE Fall 2013 Newsletter – New Employee Edition (Rev 8-13-2013) 8/13/2013 Jennifer Seibert
2013-2014 Employee & Employer Contribution Tables – How do I know the contributions are correct? (rev 7-24-2013) 7/24/2013 Jennifer Seibert
PERALTA BENEFITS – EVERYONE Spring 2013 Open Enrollment Announcement (mailed 4/24/13) 4/24/2013 Jennifer Seibert
Pre and Post retirement checklist, page 24 4/24/2013 Jennifer Seibert
PERALTA BENEFITS – EVERYONE  (mailed 4/16/2013) 4/16/2013 Jennifer Seibert
Peralta CCD Insurance Carrier Mobile Apps 4/15/2013 Jennifer Seibert
Group Insurance Benefit Rate Matrix 2013-2014 4/19/2013 Jennifer Seibert
PERALTA BENEFITS MINI-FAIR & FLU SHOTS (Tuesday, February 5, 2013) 2/5/2013 Jennifer Seibert
UPDATE: New Employee Benefit Orientation & Retirement Appointment Schedule April – June 2013 4/8/2013 Jennifer Seibert
PERALTA BENEFITS – EVERYONE Jauary 8, 2013 1/8/2013 Jennifer Seibert
Benefits Mini Fair Thursday, November 15, 2012- 11/15/2012 Jennifer Seibert
Flexible Benefits Plan Open Enrollment Announcement for 2013 11/1/2012 Jennifer Seibert
Section 125 – Flexible Benefit Plan Handbook 2013 11/1/2012 Jennifer Seibert
PERALTA BENEFITS – EVERYONE October 31, 2012 10/31/2012 Jennifer Seibert
Peralta Benefits Everyone Newsletter (October 2012) Supplement with Statutory Contribution Rates 2012-2013 10/1/2012 Jennifer Seibert
Peralta  Medical Benefit Rate Matrix 2012-2013 9/4/2012 Jennifer Seibert
December 2011 – Peralta Benefits – Everyone Newsletter 12/1/2011 Jennifer Seibert
VERIP Election Information & Forms 5/25/2011 Jennifer Seibert
Benefits Newsletter March/April 2011 4/19/2011 Jennifer Seibert
VERIP Exhibits for Faculty 4/15/11 4/19/2011 Jennifer Seibert
VERIP Exhibits for Local 39 , Administrators and Confidentials 4/15/11 4/19/2011 Jennifer Seibert
Benefits Survey 2011 4/11/2011 Jennifer Seibert
VERIP forms fro Managers, Confidentials, & 39 4/1/2011 Jennifer Seibert
VERIP forms for PFT including Overview, Exhibits and Universal Benefit Enrollment Form forms for PFT including Overview, Exhibits and Universal Benefit Enrollment Form 3/31/2011 Jennifer Seibert
Benefits Fringe Committee Meeting 311 3/30/2011 Jennifer Seibert
Benefits Fringe Committee Meeting 1210 2/15/2011 Jennifer Seibert
Spring 2011 Orientations & Workshops 1/13/2011 Jennifer Seibert
403(b) Vendor List September 2010 1/13/2011 Jennifer Seibert
Benefits Fringe Committee Meeting 1110 12/7/2010 Jennifer Seibert
Benefits Fringe Committee Meetin 1010 11/3/2010 Jennifer Seibert
Benefits Fringe Committee Meeting 0910 10/8/2010 Jennifer Seibert
457 Vendor List September 2010 10/6/2010 Jennifer Seibert
August 2010 Benefits Fringe Committee Meeting 9/8/2010 Jennifer Seibert
Initial Announcement of Dependent Eligibility Audit April 2010 4/6/2010 Jennifer Seibert
Peralta Benefits Dependent Eligibility Matrix 4/6/2010 Jennifer Seibert
April 2010 Campus Workshops 4/6/2010 Jennifer Seibert
403(b) Tax Deferred Plan Document 3/8/2010 Jennifer Seibert
Salary Reduction Agreement September 2009 9/25/2009 Jennifer Seibert
Fall Fun Fringes 9/17/2009 Jennifer Seibert
Approved Vendor List August 2009 8/10/2009 Jennifer Seibert
What Now? Navigating the Current Economic Climate 8/10/2009 Jennifer Seibert
New Rules, New Players, New Opportunties 8/10/2009 Jennifer Seibert
August 2009 Vendor List 8/10/2009 Jennifer Seibert
Welcome to the 457 Plan 8/10/2009 Jennifer Seibert
403(b) Welcome 8/10/2009 Jennifer Seibert
Salary Reduction Agreement August 2009 8/5/2009 Jennifer Seibert
403(b) Vendor List August 2009 8/5/2009 Jennifer Seibert
Salary reduction Agreement July 2009 7/13/2009 Jennifer Seibert
District Picnic 2009-tickets $15 6/29/2009 Jennifer Seibert
District Picnic and Summer Workshops 6/24/2009 Jennifer Seibert
403(b) Vendor List March 2009 3/24/2009 Jennifer Seibert
Salary Reduction Agreement Form April – June 2009 3/23/2009 Jennifer Seibert
Staff & Retiree Appreciation 3/23/2009 Jennifer Seibert
February & March Professional Development Day Schedule 2/20/2009 Jennifer Seibert
403(b) Investment Options 1/9/09 1/14/2009 Jennifer Seibert
Salary Reduction Agreement Revised 1/2009 1/13/2009 Jennifer Seibert
Benefits Spotlight: Tax Deferred Compliance Update-IRS extends deadlines 1/7/2009 Jennifer Seibert
Professional Development Day Workshops: Adjunct Open Enrollment/403(b) Plan Update/FDIC Consumer Protections 1/7/2009 Jennifer Seibert
Staples 10% Discount 12/8/2008 Jennifer Seibert
Smart Gift Giving – Employee Assistance Services 12/8/2008 Jennifer Seibert
403(b) Workshops 12/8/2008 Jennifer Seibert
Benefits Spotlight 403(b) Plan changes 11/26/2008 Jennifer Seibert
Benefit Spotlight 403(b) Plan Changes 11/26/08 11/26/2008 Jennifer Seibert
Benefit Spotlight 403(b) Plan Changes 11/26/08 11/26/2008 Jennifer Seibert
Fall 2007 Adjunct Faculty Open Enrollment Announcement 8/1/2007 Jennifer Seibert
Adjunct Open Enrollment Form Fall 2007 8/1/2007 Jennifer Seibert
Adjunct Open Enrollment Announcement Fall 2007 8/1/2007 Jennifer Seibert
Prudent Buyer Incentive Plan July 1, 1997 6/8/2007 Jennifer Seibert
March 2007 Newsletter: Benefits Spotlite-Health & Wellness 3/26/2007 Jennifer Seibert
—March 2007 Newsletter: Benefits Spotlite-Health & Wellness 3/23/2007 Jennifer Seibert
Spring 2007 Adjunct Newsletter 1/26/2007 Jennifer Seibert
Change of Address 9/14/2006 David Betts
Frequently Asked Questions- Back to Blue Cross & I have no card? 8/31/2006 Jennifer Seibert
—Back to Blue Cross effective September 1, 2006 7/31/2006 Jennifer Seibert
RSG 5/15/2006 Teodora Washington
Benefits Front Page 4/25/2006 Teodora Washington
Summary Plan Description (Active) for CoreSource, Medco and Spectera 3/24/2006 Teodora Washington
Summary Plan Description (Retiree) for CoreSource, Medco and Spectera 3/24/2006 Teodora Washington
Flex Day Workshop: 457 Plan; change in 403(b) Plan Administration 1/9/2006 Jennifer Seibert
403(b) and 457(b) Salary Reduction Agreement Form 1/9/2006 Jennifer Seibert
Enrollment Procedures and Additional Informtaion for 403(b) & 457(b) Plan Participation 1/9/2006 Jennifer Seibert
403(b) & 457(b) Plan Limits 1/9/2006 Jennifer Seibert
District Announcement of New 403(b) Plan Administrator; Introduction of New 457(b) Plan 1/9/2006 Jennifer Seibert

 

  • Benefits & Medical Information

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  • Peralta Community College District

    The district comprises four campuses serving northern Alameda County.
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