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Benefits Resource Library Current Plan Year

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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

CBIZ FSA Enrollment Form

Flexible Spending SPD: 2014-spd-003

CBIZ FSA Claim-form

CBIZ FSA Change in Status or Termination Form

My Plans by CBIZ Direct Deposit Instructions

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 $280/month

Transportation Expenses $280/month (Public transportation/vanpool)

CBIZ COMMUTER – Transition Guide

CBIZ Pre-Tax Commuter Handbook

CBIZ Pre-Tax Commuter Enrollment Form

Pre-Tax Commuter SPD: peralta-132-doc

CBIZ PRE-TAX COMMUTER (PARKING ONLY) Claim-form

*CBIZ debit card must be used for eligible transit expenses starting 1/1/2021.

My Plans by CBIZ Direct Deposit Instructions

CBIZ CONTACT INFORMATION

EMAIL: cbizflex@cbiz.com

TELEPHONE: 1-925-956-0514

 

Medicare Reimbursement Direct Deposit

If you are currently receiving direct deposits from CBIZ for your Medicare Premium Reimbursements and are not registered online on the CBIZ platform, click on the link below. Once registered you will be able to manage your direct deposit information.

CBIZ Online Registration

 If you are already registered on the CBIZ platform and would like to update your direct deposit information you can click on the link below.

https://myplans.cbiz.com/

My Plans by CBIZ Direct Deposit Instructions

Medicare Downloads

Medicare A, B & D Premium Reimbursement Plan Summary Plan Description (SPD) 2015

Medicare-A-and-B-and-D-Premium-Claim-Form-Revised-11-24-21

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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