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Change Forms
Change Forms![]()
Change Forms
SISC Membership Change Form (add or drop dependents, change of address, name, DOB, etc.)
*Must have a qualifying event to add or drop dependents with proper documents. Employees have 30 days from the date of the qualifying event to turn in any paperwork and supporting documents.
*Must have a qualifying event to add or drop dependents with proper documents. Employees have 30 days from the date of the qualifying event to turn in any paperwork and supporting documents.
Please contact the Benefits Department regarding any questions.
Beneficiary Form -change life insurance beneficiary at any time.
Voluntary deduction Cancellation Form
* Please note if you have deductions that are coming out pre-taxed you will have to wait until the end of the plan year to cancel it.
Forms
Claim Forms
Claim Forms![]()
Claim Forms
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Anthem Select Blue Cross
Claims mailing address: P. O. Box 60007
Los Angeles, CA 90060-0007 (800) 825-5541 |
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New Hire Paperwork
New Hire Paperwork![]()
New Hire Paperwork
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24-25 RATES
*Certificated/ Management employees working a 50-90% FTE have to pay a percentage of the full premium amount equivalent to your percentage leave. Opt Out Form *Only for employees that are working an FTE less than 90%. Employees that choose to opt out will not receive any stipend. |
Affidavits
Affidavits![]()
Affidavits
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Employees would be responsible for paying the taxes of their partner's health benefits.
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