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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

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

 

 

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.

 

 

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

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

 

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

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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THE HUB NEWSLETTER

Volume 3 

Volume 2

Volume 1

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  • Benefits & Medical Information

    Wednesday 23 June 2021
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  • Peralta Community College District

    The District comprises four colleges serving northern Alameda County.
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