Benefits & Medical Information Home
2021 OPEN ENROLLMENT
May 1 – May 31, 2021 for changes effective July 1, 2021
Open Enrollment Activities
Virtual Health Fair Meetings
May 10 – May 14, 2021
Benefits Office Virtual Q & A
May 18, 2021 & May 25, 2021
Out of an abundance of caution, our activities will still be virtual this year. Click the link below for the carrier virtual presentation schedules & Q&A sessions hosted by the Benefits Office.
Open enrollment for benefits will end on May 31, 2021 11:59 PM
Open enrollment is the annual opportunity for benefit-eligible employees/retirees to add or delete an eligible dependent and make plan changes effective July 1, 2021.
Visit the BenefitBridge Resource Center located under the “more” tab, top right of your screen after you login. When completing your online Open Enrollment changes you can check to ensure that your District paid life insurance beneficiaries are current.
Please review your current benefits and the 2021-2022 Monthly Contribution Rate Matrix effective July 1, 2021 (page 18).
Part-time Faculty Open Enrollment is currently closed pending the Fall 2021 open enrollment announcement.
Click on the video link below to know more about this year’s Open Enrollment.
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
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
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
District-Paid Disability Insurance
Long Term Disability Certificate
Employee Assistance Program (EAP) Administered by MHN
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 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
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
________________________________________________________________________________________________________
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
Important Links
(July 1, 2020 – June 30, 2021)
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 – 2021 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
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
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
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
District-Paid Disability Insurance
Long Term Disability Certificate
Employee Assistance Program (EAP) Administered by MHN
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 Handbook with Enrollment Form- 2021
Flexible Spending SPD: 2014-spd-003
PENSION DYNAMICS FSA Claim-form Plan Year 2020
CBIZ FSA Claim-form Plan Year 2021
CBIZ Direct-deposit-authorization
CBIZ FSA Change in Status or Termination Form
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
CBIZ Pre-Tax Commuter Handbook with Enrollment Form – 2021
Pre-Tax Commuter SPD: peralta-132-doc
PENSION DYNAMICS Pre-Tax Commuter Claim Form (Eligible expenses prior to 12/31/2020
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
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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