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Benefits Services

The following documents require Acrobat Reader -- Please see the Forms page for updated Benefit forms.

Benefit Providers

The Chabot-Las Positas Community College District currently offers the following benefits for eligible employees:

Benefit

Carrier

Evidence of Coverage (EOC)

Summary

Universal

Enrollment

 

Required Form

   

Health

 

Anthem Blue Cross California Care

  • High HMO $10

 

  • Low HMO $30

Informational Flyer

Member Access Flyer

 

Anthem Blue Cross PPO

 

Kaiser Permanente Health HMO

  • High HMO $5
  • Low HMO $20

 

 

 

 

 

 

 

 

 

 

 

 

 

Dental

Delta Dental of California

  • Standard
  • Enhanced

 

 

Vision

 

Vision Service Plan

VSP Claim Form

Life

 

Anthem Blue Cross Life Insurance

Life Insurance Enrollment Form

 

LTD

 

Fort Dearborn Life Insurance Company

(Long Term Disability)

LTD Insurance Enrollment Form

 

Flexible

Spending

Account

Employee Benefits Specialist - EBS

  • Medical Spending Account - $2,500 Per Year
  • Dependent Care Spending Account - $5,000 Per Year

FSA Claim Form

FSA Dependent Care Assistance Plan

FSA Direct Deposit Form

Employee Assistance

Plan

Concern EAP

Company Code: Chabot Las Positas

EAP SERVICES FLYER

Supplemental Life

 

 

Anthem Blue Cross Life Insurance Company

Salary Reduction Plans

Envoy / Plan Services

403(b) & 457

 

403b/TSA Enrollment Form

The District's 403b Administrators

Updating or establishing PERS account, need to fill out next two forms:

Questions?  Please contact Payroll at (925) 485-5228 or Benefits at (925) 485-5504.

  • Pre-tax retirement savings on a voluntary basis.

Workers' Compensation

Coverage for work related injury/illness.

Supervisor Instructions

Supervisor Report of Injury

Approved Occupational Health Clinic Providers

Workers' Compensation ( DWC1) Claim Form

TSA In Lieu

of Medical Plan

Full-time employees electing not to enroll in a medical plan and who provide proof of other medical coverage, may elect to have a $275 Board approved TSA purchased monthly by the District.

Domestic

Partner

Benefits

Certificated: To include those individuals who meet the requirements for domestic partnership which are set forth in CA Family Code Section 297 and the CLPCCD - CLPFA Bargaining Agreement, Article 20.A.3.

Classified: Benefits for same and opposite gender partners with proper documentation and meet the requirements which are set forth in CA Family Code, Section 297, CLPCCD Board Policy and CLPCCD S.E.I.U 1021 Bargaining Agreement, Article 16.