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For part-time faculty, click here
For retirees, click here
For ACA-eligible employees, click here

Important Forms & Documents

Medical Plans

SISC Kaiser Traditional HMO Plan

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SISC Kaiser Traditional HMO Summary of Benefits & Coverage
SISC Kaiser Traditional HMO Enrollment Form

Please download the form and sign with a digital signature before submitting.

You can submit your form in person or via mail to the PCCD Benefits office at 333 East 8th St, Oakland, CA 94606.

SISC Anthem PPO Plan

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SISC Anthem PPO Summary of Benefits & Coverage
SISC Anthem PPO Enrollment Form

Please download the form and sign with a digital signature before submitting.

SISC Evidence of Coverage Pharmacy Benefit

PCCD Kaiser Permanente Reimbursement Form

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Kaiser Reimbursement Form

Dental / Vision

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Group Life Insurance

CBIZ

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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

Navia

Navia Benefit Solutions will be the administrator of our Flexible Spending Accounts (FSA) and Commuter benefits, effective January 1, 2023.

It's important to note that a change has been made to the FSA plan design for 2023. The 2023 FSA plans will have the 2 ½ month grace period instead of the carryover feature. The grace period gives you an additional 2 ½ months to incur expenses against your Health Care and Day Care arrangements. This means that you will have until 3/15/2024 to incur services against your 2023 FSA. All expenses incurred during the 2 ½ month grace period will automatically deduct from the prior year's account first, and any remaining claim balance will then be applied to your current plan year.

If you participated in the 2022 Health Care FSA with CBIZ and have remaining funds at the end of the 90-day claims runout period, remaining balances of up to $570 will be transferred to Navia as a one-time carryover.

The Commuter account balances will continue the carryover feature as it has in the past.

For 2023, the maximum amount that you can contribute is:

  • $3,050 for healthcare/medical FSA
  • $5,000 (per household) for dependent care FSA
  • $300 each for commuter benefits (transit and parking)

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