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Benefits Resource Library Previous Plan Years

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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 – 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

 

2020-2021 Kaiser Senior Advantage Plans Summary of Benefits & Coverage

 

 

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

  

  

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

 

 

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 – 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 effective 1/1/2021.

CBIZ Direct-deposit-authorization

Medicare Downloads

  

  

Open Enrollment 2020-2021 Virtual Health Fair Meetings Schedule, Videos & Materials

Virtual Health Fair Meetings Schedule

Anthem PPO Traditional & Lite Self-Funded Medical Plans

*Administered by Trustmark

Anthem PPO Traditional & Lite Self-Funded Plans 2020-2021 Active Employee Open Enrollment Presentation (Administered by Trustmark)

Anthem PPO Traditional & Lite Self-Funded Plans 2020-2021 Retiree Open Enrollment Presentation (Administered by Trustmark)

Registering on myTrustmarkBenefits.com

LiveHealthOnline Flyer How to Register

Using LiveHealth Online

Understanding your Explanation of Benefits  (EOB)

Download the myTrustmarkBenefits Mobile App

Lifestyle Management Health Center

Lifestyle Management Overview

Stay connected with myTruskmarkBenefits Wire

Active&Fit DIRECT – Member FAQ’s

Kaiser Permanente Traditional HMO & Senior Advantage Medical Plans

Kaiser Permanente Traditional HMO Plans 2020-2021 Active Employees & Retirees without Medicare Coordination Presentation – Video link included

Kaiser Permanente Senior Advantage Plans 2020-2021 Retirees Age 65 & Over with Medicare Presentation – Video link included

Kaiser Permanente Senior Advantage Plans 2020-2021 Retirees Age 65 & Over with Medicare Presentation – Virtual Health Fair Video link included

•Delta Dental DHMO plan for Kaiser Senior Advantage members included in presentation

KP Mobile App Flier 2020

KP Accessing Telehealth

KP ChooseHealthy-ComplementaryCare 2020

KP Wellness-Coaching by Phone 2019

MinuteClinic Traveling Members

myStrength_Flyer_National

Voya District Paid Life & Disability Insurance

Peralta CCD – Voya Open Enrollment Recorded Virtual Meeting Presentation   Password is “2020PCCDoe”.

Voya District Paid Life, A D & D & Disability Insurance Presentation – Open Enrollment 2020-2021 

Everest Funeral Planning

Travel Assistance

UHC Vision Plans (Bundled with Anthem PPO Traditional & Lite Medical Plans)

UHC Vision – Welcome brochure

UHC Vision $ 15.00 copay plan bundled with Anthem PPO Traditional & Lite Medical Plans – L39

UHC Vision $ 10.00 copay plan bundled with Anthem PPO Traditional & Lite Medical Plans –  All groups except L39

UHC Vision Contact Formulary List – January 2020

Use your UHC vision benefits at Warby Parker

Your benefits could go further with Warby Parker

Delta Dental PPO Self-Funded Dental Plan

Delta Dental PPO Self-Funded Plan Benefits Overview Presentation – Active Employees

Find a Network Dentist

Estimate Your Costs

Pre-treatment Estimate

Meet your new value-added features

Delta Dental PPO AB-528 Dental Plan – Retiree Faculty

Delta Dental PPO AB-528 Plan Benefits Overview Presentation – Retired Faculty

*Offered to Faculty members at the time of retirement along with Dental COBRA continuation offer. Plan not available during retirement if not elected during the applicable offer period following retirement.

UHC Dental DHMO Plan

UHC Dental DHMO – Welcome brochure

UHC Dental Select Managed Care CA Open Enrollment Brochure

UHC DHMO – Direct Compensation Dental Plan Evidence of Coverage

UHC Dental DHMO – Direct Compensation (DC) Contributory CA250/covered dental services CA D1065

Cigna Voluntary Term Life Insurance

CIGNA Open Enrollment Recorded Virtual Meeting Presentation  Password:2020PCCDoe

VOLUNTARY TERM LIFE AND VOLUNTARY ACCIDENTAL DEATH AND DISMEMBERMENT (AD&D) INSURANCE SUMMARY (10/2017)

Cigna Life Insurance Change Form Application

VSP Voluntary Vision Plan

VSP Open Enrollment Recorded Virtual Meeting Presentation Password: 2020PCCDoe

VSP Vision Benefits Summary

Employee Assistance Program – MHN

MHN (EAP) Open Enrollment Recorded Virtual Meeting Presentation Password: 7t!t0n#?

Evidence of Coverage

  

  

  

  

Plan Year July 1, 2019 – June 30, 2020

2019-2020 PCCD Employee Benefits Guide with Rate Matrix

PCCD Required Documentation Matrix

Registration and login online instructions for BenefitBridge

BenefitBridge Secure Enrollment Portal

Kaiser Permanente Downloads

2019-2020 Traditional Plan Summary of Benefits & Coverage

2019-2020 Senior Advantage Summary of Benefits & Coverage

Self-funded Plan Downloads

2019-2020 Summary of Benefits & Coverage

Dental

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

Current year forms & Documents:

Pre-tax Commuter Expense under IRS Code 132

Contribution Limit Increase for 2020:

The maximum amount you may contribute to each account cannot exceed the maximum amount specified in Code Section 132(f).

The maximum amounts are:

  1. Parking Expenses $270/month
  2. Transportation Expenses $270/month (Public transportation/vanpool)

Medicare Downloads

2018-2019 PCCD Employee Benefits Guide with Rate Matrix click here

 News Letter Ribbon 2018

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2017-2018 PCCD Employee Benefits Guide

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Kaiser Permanente Downloads

2018-2019 Traditional Plan Summary of Benefits & Coverage

2018-2019 Senior Advantage Summary of Benefits & Coverage

Self-funded Plan Downloads

2018-2019 Summary of Benefits & Coverage

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