Self-funded Plan Downloads

2019-2020 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.


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 / Vision / District-paid insurance

Additional Documents

Employee Assistance Program (EAP) Administered by MHN
Flexible Spending Medical and Dependent Day Care Expenses under IRS Code 125
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:

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

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

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