Benefits Resource Library Previous Plan Years
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
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 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
- Medicare A, B & D Premium Reimbursement Plan Summary Plan Description (SPD) 2015
- Medicare-A-and-B-and-D-Premium-Claim-Form-Revised-11-24-2020
- Medicare Reimbursement Plan Policy Statement 10.2015
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
Registering on myTrustmarkBenefits.com
LiveHealthOnline Flyer How to Register
Understanding your Explanation of Benefits (EOB)
Download the myTrustmarkBenefits Mobile App
Lifestyle Management Health Center
Stay connected with myTruskmarkBenefits Wire
Active&Fit DIRECT – Member FAQ’s
Kaiser Permanente Traditional HMO & Senior Advantage Medical Plans
•Delta Dental DHMO plan for Kaiser Senior Advantage members included in presentation
KP ChooseHealthy-ComplementaryCare 2020
KP Wellness-Coaching by Phone 2019
MinuteClinic Traveling Members
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
UHC Vision Plans (Bundled with Anthem PPO Traditional & Lite Medical Plans)
UHC Vision $ 15.00 copay plan bundled with Anthem PPO Traditional & Lite Medical Plans – 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
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
Cigna Life Insurance Change Form Application
VSP Voluntary Vision Plan
VSP Open Enrollment Recorded Virtual Meeting Presentation Password: 2020PCCDoe
Employee Assistance Program – MHN
MHN (EAP) Open Enrollment Recorded Virtual Meeting Presentation Password: 7t!t0n#?
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
- 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
Self-funded Plan Downloads
2019-2020 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)
Dental
- Delta Dental PPO Plan – Plan Summary
- UHC Dental – Direct Compensation DHMO Dental Plan Evidence of Coverage
Vision
District-Paid Life Insurance
District-Paid Disability Insurance
Employee Assistance Program (EAP)
- EAP Evidence of Coverage: 2019-eap-peraltacommunitycollege14eoc
- EAP Summary Benefit Comparison: 2016-mhn-eap-sbc
Flexible Spending Medical and Dependent Day Care Expenses under IRS Code 125
Current year forms & Documents:
- Handbook with Enrollment Form- 2020
- Flexible Spending SPD: 2014-spd-003
- Claim-form
- Direct-deposit-authorization
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:
- Parking Expenses $270/month
- Transportation Expenses $270/month (Public transportation/vanpool)
- Handbook with Enrollment Form – 2020
- Pre-Tax Commuter SPD: peralta-132-doc
- 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
2018-2019 PCCD Employee Benefits Guide with Rate Matrix click here
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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
- 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
Self-funded Plan Downloads
2018-2019 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)
- 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)
CoreSource Links:
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