Open Enrollment Important Documents

Employee Assistance Program (EAP)

Medical Plans

Anthem PPO Traditional & PPO LiteSelf-funded Plans Administered by Trustmark

Kaiser HMO Plans – Active Employees & Non-Medicare Retirees

2022-2023 Kaiser Traditional Plans Summary of Benefits & Coverage

 

Universal Benefit Enrollment Form – Retiree & Exceptional Processing

Universal Benefit Enrollment Form – Retiree & Exceptional Processing

*Active Employees must make changes via BenefitBridge

*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.

2022-2023 Kaiser Traditional Plans Evidence of Coverage

Kaiser Senior Advantage Plans – Retirees (Medicare)

2022-2023 Kaiser Senior Advantage Plans Summary of Benefits & Coverage

 

Universal Benefit Enrollment Form – Retiree & Exceptional Processing

Universal Benefit Enrollment Form – Retiree & Exceptional Processing

*Active Employees must make changes via BenefitBridge

*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.

2022-2023 Kaiser Senior Advantage Plans Evidence of Coverage

PCCD Kaiser Permanente Reimbursement Form

Kaiser Reimbursement Form

Dental / Vision

Group Life Insurance

CBIZ

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).

CBIZ Open Enrollment 2021 Presentation

Current year forms & Documents:

Flexible Spending SPD: 2014-spd-003

CBIZ CONTACT INFORMATION

EMAIL: cbizflex@cbiz.com

TELEPHONE: 1-800-815-3023, Option 4

Pre-tax Commuter Expense under IRS Code 132

CBIZ Open Enrollment 2021 Presentation

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 $280/month

Transportation Expenses $280/month (Public transportation/vanpool)

Pre-Tax Commuter SPD: peralta-132-doc

*CBIZ debit card must be used for eligible transit expenses starting 1/1/2021.

CBIZ CONTACT INFORMATION

EMAIL: cbizflex@cbiz.com

TELEPHONE: 1-800-815-3023, Option 4

Medicare Reimbursement Direct Deposit and Downloads

Medicare Reimbursement Direct Deposit

If you are currently receiving direct deposits from CBIZ for your Medicare Premium Reimbursements and are not registered online on the CBIZ platform, click on the link below. Once registered you will be able to manage your direct deposit information.

CBIZ Online Registration

 If you are already registered on the CBIZ platform and would like to update your direct deposit information you can click on the link below.

https://myplans.cbiz.com/

My Plans by CBIZ Direct Deposit Instructions

Medicare Downloads

Medicare A, B & D Premium Reimbursement Plan Summary Plan Description (SPD) 2015

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 benefitberidge@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