Benefits Resource Library Current Plan Year
July 1, 2020 – June 30, 2021
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
Medical Plans
Kaiser HMO Plans
2020-2021 Kaiser Traditional Plans Summary of Benefits & Coverage
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 HMO Plan Downloads
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
Anthem PPO Traditional & PPO Lite Self-funded Plans Administered by Trustmark
Self-funded Plan Download
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
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)
Voluntary Vision
District-Paid Life Insurance
District-Paid Disability Insurance
Employee Assistance Program (EAP)
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 effective 1/1/2021.
CBIZ Direct-deposit-authorization
Medicare Downloads
PDF files