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Pajaro Valley Unified School District

District
Alianza Charter School Amesti Elementary School Ann Soldo Elementary School Aptos High School Aptos Junior High School Bradley Elementary School Calabasas Elementary School Cesar E. Chavez Middle School Diamond Technology Institute Duncan Holbert School and Early Start Edward A. Hall Middle School Freedom Elementary School H. A. Hyde Elementary School Hall District Elementary School Lakeview Middle School Landmark Elementary School Linscott Charter School MacQuiddy Elementary Mar Vista Elementary School Mintie White Elementary School New School Community Day High School Ohlone Elementary School Pacific Coast Charter Pajaro Middle School Pajaro Valley High School Pajaro Valley Unified School District Radcliff Elementary School Renaissance High School Rio Del Mar Elementary School Rolling Hills Middle School Starlight Elementary School Valencia Elementary School Virtual Academy WASC Adult Education Watsonville Charter School of The Arts Watsonville High School
or Browse All Schools
QUICK LINKS
https://www.pvusd.net/Departments/Business-Services/Benefits/Forms/

Forms

Claim Forms

Claim Forms

Blue Shield of California
Claims mailing address:
P. O. Box 272540
Chico, CA   95927
(855) 256-9404
Anthem Select Blue Cross
Claims mailing address:
P. O. Box 60007
Los Angeles, CA 90060-0007
(800) 825-5541
Kaiser
Claims mailing address:
P.O. Box 261155
Plano TX 75026
(800) 392-8649
Navitus
Claims mailing address:
P. O. Box 272540
Chico, CA   95927
(800) 642-6155
Delta Dental
Claims mailing address:
P. O. Box 997330
Sacramento CA. 95899-7330
(866) 499-3001
VSP
Claims mailing address:
3333 Quality Drive
Rancho Cordova, CA   95670
(800) 877-7195
New Hire Paperwork

New Hire Paperwork

 
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

Employees would be responsible for paying the taxes of their partner's health benefits.
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.
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.
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