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Flexible Spending Account (FSA) Open Enrollment

 

November 1 – December 9, 2021, for changes effective January 1, 2022.

New IRS limits and OE deadline extended to December 9, 2021. 

It’s that time of the year again to enroll in a healthcare or dependent care FSA for 2022. Starting this Open Enrollment, you will need to re-elect your Commuter Benefits effective January 1, 2022, for the plan year 2022.

 

For 2021*, the maximum amount that you can contribute are:

·        $2,850 for healthcare/medical FSA

·        $5,000 (per household) for dependent care FSA

·        $280 each for commuter benefits (transit and parking)

*2022 IRS contribution limits were released November 10th, 2021

 

What is a Flexible Spending Account (FSA)?

An FSA is a personal expense account that works with your District health plans, allowing you to set aside a portion of your salary pre-tax to pay for qualified medical and dependent care expenses. The dollars you set aside can pay for eligible expenses for you, your spouse, and eligible dependents.

 

How does it work?

 

  • Estimate your annual election – During your online enrollment, use the FSA calculator to estimate your expenses for the plan year and come up with how much your annual election should be.
  • Deductions will be taken out of your paycheck – Your annual election amount will be evenly deducted pre-tax from your paycheck throughout the plan year. 
    • Healthcare FSA: You cannot change your annual election amount after the plan start unless you have a qualified change in status.
    • Dependent Care FSA: You can change your elections if you have a qualified change in status, there is a significant cost change or a change in coverage.
    • Commuter Benefit – For the Commuter Benefits Accounts, the participants may change their deduction amount as often as monthly. Changes MUST be submitted to the Employer prior to the beginning of the month.

Access your funds – you can use your CBIZ Benefit Card to pay for your qualified expenses. You can see a more comprehensive list on our website at https://myplans.cbiz.com. Click on Tools & Support, then go to Quick Links to Health Expense Table.

 

How to Enroll

Enrollments are done online by visiting https://myplans.cbiz.com. Refer to the FSA Online Enrollment Instructions for step-by-step instructions on how to complete your enrollments for 2022.

 

Handbooks & Enrollment Instructions

Section 125 / Flexible Benefit Plan (Plan) Employee Handbook. Valid for plan years on or after January 1, 2022

Section 132/Pre-Tax Commuter Expense Program Employee Handbook. Valid for plan years on or after January 1, 2022.

Flexible Spending Online Enrollment Instructions.

FSA Open Enrollment Email Announcement

 

 

For Assistance

 

For assistance with your Flexible Spending Account questions and Online Enrollment, please contact

the CBIZ Service Center at 800.815.3023, option 4, or email cbizflex@cbiz.com.

 

For employee eligibility and plan questions, please contact the District, Benefits office at 510.466.7229
or email
benefits@peralta.edu

 

 

 

 

 

 

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 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 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

  

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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    Saturday 27 November 2021
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