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Benefits & Medical Information Home

 

 

 

Important Links

 

2020 Employee Open Enrollment Benefits Newsletter/Announcement

2020 Retiree Open Enrollment Benefits Newsletter/Announcement

2020 – 2021 PCCD Employee Benefits Guide with Monthly Contribution Rate Matrix

2020 – 20201 PCCD Retiree Benefits Guide

PCCD Required Documentation Matrix

Registration and login online instructions for BenefitBridge

BenefitBridge Secure Enrollment Portal

403 (b) & 457 (b) Plan Information

Voluntary Benefits

 

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 benefitbridge@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

 

 

 

 

 

 

Benefits Resource Libraries -Current & Previous Plan Years

*Located under the Navigation tab top left of webpage.

 

 

Current Plan year ( July 1, 2020 – June 30, 2021 ) Resource Library Below

 

  

 

Medical Plans

 

 

Kaiser HMO Plans 

 

2020-2021 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

 

 

2020-2021 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

  

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

 

 

2020-2021 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)

 

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 

 

 

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

 

 

Vision (Bundled With Medical Plans)

 

 

Kaiser Vision Plan & UHC Vision Plans – Benefits Summary

 

 

Voluntary Vision

 

 

VSP (Voluntary Vision) – Benefits Summary

 

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

 

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).

 

Current year forms & Documents:

CBIZ FSA – Transition Guide

FSA Handbook with Enrollment Form- 2021

Flexible Spending SPD: 2014-spd-003

FSA Claim-form

Direct-deposit-authorization

 

Pre-tax Commuter Expense under IRS Code 132

 

 

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

Pre-Tax Commuter Handbook with Enrollment Form – 2021

Pre-Tax Commuter SPD: peralta-132-doc

Pre-Tax Commuter Claim Form

Direct-deposit-authorization

 

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

 

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THE HUB NEWSLETTER

Volume 3 

Volume 2

Volume 1

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  • Benefits & Medical Information

    Wednesday 27 January 2021
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  • Peralta Community College District

    The District comprises four colleges serving northern Alameda County.
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