Retiree Information

HMO Medical Plans and Enrollment Forms

HMO Plans

• Kaiser Permanente Sr Advantage $10 (2 pers w/Medicare) Benefits Summary
• Kaiser Permanente Sr Advantage Enrollment Form (2 pers w/Medicare)
• Kaiser Permanente Sr Advantage $0 (1 pers w/Medicare) Classified ONLY Benefits Summary
• Kaiser Permanente Sr Advantage Enrollment Form (1 pers w/Medicare)
• Blue Shield 65 Plus Advantage Benefits Summary
• Enrollment Request For Blue Shield 65 (HMO) Employer Group Enrollment Form
• Blue Shield of California HMO 65
• SISC III Enrollment Form for Blue Shield HMO Full Network

PPO Plans

• Blue Shield PPO EGWP 100A Benefits Summary
• SISC CompanionCare/PPO EGWP Rx Enrollment Form
• Companion Care Benefits Summary
• SISC CompanionCare/PPO EGWP Rx Enrollment Form

 

Prescription Coverage

• Navitus Medicare Rx Information

 

Additional Information

• HIPAA Notice of Privacy Practices

HMO Plan

• Delta Care HMO Benefits Summary

 

PPO Plans

• • Delta Dental PPO 1500 Benefits Summary
  • Delta Dental PPO Unlimited Benefits Summary

• VSP

HMO Medical Plans and Enrollment Forms

HMO Plans

• Blue Shield Trio Benefits Summary
• SISC III Enrollment Form for Blue Shield
• Blue Shield Full Network Benefits Summary
• SISC III Enrollment Form for Blue Shield
• Kaiser Permanente $0; Rx $5-20 (30 Day) Benefits Summary
• Kaiser Permanente Enrollment Form
• Kaiser Permanente $15; Rx $5-20 (30 Day) Benefits Summary
• Kaiser Permanente Enrollment Form

 

PPO Plans

• Blue Shield 90G $20; Rx $5-20 (30 Day) Benefits Summary
• Blue Shield 100A $10; Rx $5-20 (30 Day) Benefits Summary
• Blue Shield 2-Tier Anchor Bronze Benefits Summary
• SISC III Enrollment Form for Blue Shield

 

Prescription Coverage

• Navitus Medicare Rx Information

 

Additional Information

• HIPAA Notice of Privacy Practices

HMO Plan

• Delta Care HMO Benefits Summary

 

PPO Plans

• • • Delta Dental PPO 1500 Benefits Summary
    • Delta Dental PPO Unlimited Benefits Summary

• VSP
  

HMO Medical Plans and Enrollment Forms

HMO Plans

• Blue Shield Trio Benefits Summary
• SISC III Enrollment Form for Blue Shield
• Blue Shield Full Network Benefits Summary
• SISC III Enrollment Form for Blue Shield
• Kaiser Permanente $15; Rx $5-20 (30 Day) Benefits Summary
• Kaiser Permanente Enrollment Form

 

PPO Plans

• Blue Shield 80G $20; Rx $5-20 (30 Day) Benefits Summary
• Blue Shield 90G $20; Rx $5-20 (30 Day) Benefits Summary
• Blue Shield 100A $10; Rx $5-20 (30 Day) Benefits Summary
• Blue Shield 2-Tier Anchor Bronze Benefits Summary
• SISC III Enrollment Form for Blue Shield

 

Prescription Coverage

• Navitus Medicare Rx Information

 

Additional Information

• HIPAA Notice of Privacy Practices

HMO Plan

• Delta Care HMO Benefits Summary

 

PPO Plans

• • Delta Dental PPO 1500 Benefits Summary
  • Delta Dental PPO Unlimited Benefits Summary

• VSP