Human Resource Services

Benefit

Carrier

Evidence of Coverage (EOC)

Health

Anthem Blue Cross California Care HMO

Anthem Blue Cross PPO

Kaiser Permanente Health HMO

Universal Enrollment Form

Kaiser Permanente Health HMO EOC

Dental

Delta Dental of California

Universal Enrollment Form

Vision

Vision Service Plan

Universal Enrollment Form

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 - $3,000 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

Supplemental Life

Anthem Blue Cross Life Insurance Company

• Supplemental Enrollment Form
• Anthem Optional Life Information Sheet and Rate Calculations

• (Supplemental and Dependent Life insurance is available through payroll deduction.)

Salary Reduction Plans*

Envoy / Plan Services

403(b) & 457

403b/TSA Enrollment Form

The District's 403b Administrators

457 Employee Action Form

• Pre-tax retirement savings on a voluntary basis.

Workers' Compensation*

• Coverage for work related injury/illness.

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 $175 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.