SISC Medicare-Eligible Retiree Benefits

Auxiliary, Classified, Confidential, Management

Welcome to the retiree benefits page for Medicare-eligible (65+) employees. Here you will find information about the health and wellness benefits available to you in retirement. Our goal is to help you navigate your options and make informed choices that support your well-being in this new chapter of life.

When a retiree or spouse or registered domestic partner of record becomes eligible for Medicare, the eligible person must apply for Medicare Part A and B prior to the month they turn 65. Failure to enroll in Medicare Part A and B and provide Human Resources proof of enrollment prior to the month they turn 65 may be billed a surcharge in the amount of $1,250 per month until proof of enrollment is received.

Medical Plans and Forms

District-Required Election Form

All benefit enrollment changes begin with the completion of the District-required Retiree Election Form. This form initiates your request. Depending on the type of change, you may also be required to complete the applicable insurance carrier enrollment form before your request can be processed.

2026-2027 Retiree Plan Election Form: Medicare Eligible

HMO Medical Plans

Benefit Plan Summary	Details	Retired Employee Group	Enrollment Form
Kaiser Permanente Traditional HMO (non-Medicare) - $15 OV, $5-20(30) Rx Kaiser Permanente Senior Advantage (KPSA) (Medicare) - $10 OV, $10-20(100) Rx	For 1 non-Medicare eligible person and 1 Medicare eligible person.	Auxiliary, Classified, Confidential, Management	Kaiser Permanente Traditional HMO Enrollment Form Kaiser Permanente Senior Advantage (KPSA) Enrollment Form
Kaiser Permanente Senior Advantage (KPSA) - $0 OV, $5 Rx (2026-27)	For 1 Medicare eligible person.	Classified Only	Kaiser Permanente Senior Advantage Enrollment Form
Kaiser Permanente Senior Advantage (KPSA) - $10 OV, $10-20(100) Rx (2026-27)	For 2 Medicare eligible persons.	Auxiliary, Classified, Confidential, Management	Kaiser Permanente Senior Advantage Enrollment Form
Blue Shield Access+ Full Network - $10 OV, Rx 5-20	For 1-2 Medicare eligible persons.	Auxiliary, Classified, Confidential, Management	SISC III Enrollment Form for Blue Shield HMO Full Network
Blue Shield 65 Plus (HMO) Medicare Advantage - $20 OV, Rx 10/30/50 (2026-27)	For 1-2 Medicare eligible persons.	Auxiliary, Classified, Confidential, Management	Enrollment Request For Blue Shield 65 (HMO) Employer Group Enrollment Form SISC III Enrollment Form for Blue Shield HMO Full Network

PPO Medical Plans

Benefit Plan Summary	Details	Retired Employee Group	Enrollment Forms
Blue Shield 100A - $0 OV; Rx 0-20 EGWP	For 1-2 Medicare eligible persons.	Auxiliary, Classified, Confidential, Management	SISC Enrollment Form for CompanionCare and 100A PPO (Rx EGWP)
Companion Care - Rx 9-35 EGWP	Medicare Supplement plan that pays for medically necessary services and procedures that are considered a Medicare Approved Expense	Auxiliary, Classified, Confidential, Management	SISC Enrollment Form for CompanionCare and 100A PPO (Rx EGWP)

Prescription Coverage

Navitus Medicare Rx Information

HIPAA Privacy Notice

HIPAA Notice of Privacy Practices

Dental Plans (Optional)
HMO Dental Plan
- Delta Care HMO
PPO Dental Plans
- Delta Dental 1500
- Delta Dental Incentive Unlimited
Vision Plan (Optional)
- VSP Signature Plan C $0
Additional Forms
- Dependent Eligibility Documentation Checklist

Gym Discount Programs:

Sliver & Fit Program – Blue Shield Companion Care, Blue Shield Medicare Advantage
Fitness Your Way by Tivity Health – Blue Shield 100A EGWP
Medicare Members One Pass - Kaiser Permanente Senior Advantage 65+