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
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
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:
FSA Handbook with Enrollment Form- 2021
Flexible Spending SPD: 2014-spd-003
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
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
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