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Special Voluntary Life & AD&D Open Enrollment – September 2 through September 30, 2021

Peralta CCD and Voya will have a Voluntary Life & AD&D Open Enrollment from September 2 through September 30, 2021. This is a great opportunity to sign up for additional Life & AD&D up to the guaranteed issue amounts with no medical questions for you, spouse, and child dependents.

Eligible employees and dependents can elect up to the following Guaranteed Issue amounts without going through the Evidence of Insurability (EOI) process:

Employee: $150,000 | Spouse: $50,000 | Dependent Child: $10,000

Coverage/s elected will be effective October 1, 2021.

Click here for the announcement with online instructions and rates.

 

Part-Time Hourly Faculty Benefits Open Enrollment Announcement Fall 2021

 

Part Time and Hourly Faculty and Save the Date Benefits OE Announcement Fall 2021

 

 

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 

 

2021-2022 Kaiser Traditional Plans Summary of Benefits & Coverage

Peralta-Community-College-Kaiser-HMO-10  SBC 

Peralta-Community-College-Kaiser-HMO-15 SBC 

Peralta-Community-College-Kaiser-HMO-0 SBC

Click here for additional information

 

2021-2022 Kaiser Senior Advantage Plans Summary of Benefits & Coverage

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  

 

2021-2022 Kaiser Senior Advantage HMO Delta Dental Plan Summary of Benefits & Coverage

  KPSA HMO Delta Dental Plan Summary

 

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.

 

PCCD Kaiser Permanente Reimbursement Form

Kaiser Reimbursement Form

  

Anthem PPO Traditional & PPO Lite Self-funded Plans Administered by Trustmark

 

2021-2022 Summary of Benefits & Coverage

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

  

Dental PPO

Delta Dental PPO Plan – Plan Summary 

Click here for additional information

 

UHC Dental DHMO – Direct Compensation Dental Plan

UHC DHMO – Direct Compensation Dental Plan Evidence of Coverage

UHC DHMO – Direct Compensation (DC) Contributory CA250/covered dental services CA D1065

Click here for additional information 

 

Vision (Bundled With Medical Plans)

 Kaiser Vision Plan & UHC Vision Plans – Benefits Summary

 

Voluntary Vision

 VSP (Voluntary Vision) – Benefits Summary

Click here for additional information

 

District-Paid Life Insurance

 Life Insurance Certificate

 

District-Paid Disability Insurance

 Long Term Disability Certificate

 

Employee Assistance Program (EAP) Administered by MHN

 EAP Evidence of Coverage

Click here for additional information

Flexible Spending Medical and Dependent Day Care Expenses under IRS Code 125

*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 with Enrollment Form- 2021

Flexible Spending SPD: 2014-spd-003

CBIZ FSA Claim-form Plan Year 2021

CBIZ Direct-deposit-authorization

CBIZ FSA Change in Status or Termination Form

 

CBIZ CONTACT INFORMATION

EMAIL: cbizflex@cbiz.com

TELEPHONE: 1-925-956-0514

 

Pre-tax Commuter Expense under IRS Code 132

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 $270/month

Transportation Expenses $270/month (Public transportation/vanpool)

CBIZ COMMUTER – Transition Guide

CBIZ Pre-Tax Commuter Handbook with Enrollment Form – 2021

Pre-Tax Commuter SPD: peralta-132-doc

CBIZ PRE-TAX COMMUTER (PARKING ONLY) Claim-form Plan Year 2021

*CBIZ debit card must be used for eligible transit expenses starting 1/1/2021.

CBIZ Direct-deposit-authorization

 

CBIZ CONTACT INFORMATION

EMAIL: cbizflex@cbiz.com

TELEPHONE: 1-925-956-0514

 

Medicare Downloads

Medicare A, B & D Premium Reimbursement Plan Summary Plan Description (SPD) 2015

Medicare-A-and-B-and-D-Premium-Claim-Form-Revised-11-24-20

Medicare Reimbursement Plan Policy Statement 10.2015

CBIZ Direct-deposit-authorization

 

For BenefitBridge technical assistance only, please contact BenefitBridge Customer Care at 800.814.1862;

Mon – Fri, 8:00 AM – 5:00 PM, PST or email benefitberidge@keenan.com

For assistance with your benefits questions, please contact the District, Benefits office at 510.466.7229;

Mon – Fri, 8:30 AM – 5:00 PM, PST or email benefits@peralta.edu

 

 

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Benefits Resource Libraries -Current & Previous Plan Years

*Located under the Navigation tab top left of webpage.

 

 

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THE HUB NEWSLETTER

Volume 3 

Volume 2

Volume 1

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  • Benefits & Medical Information

    Tuesday 26 October 2021
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  • Peralta Community College District

    The District comprises four colleges serving northern Alameda County.
  •