Skip to main content

2020 Open Enrollment

Welcome to the 2020 Open Enrollment!

Open enrollment will be from May 4, 2020-June 12, 2020. Just a reminder, changes done during open Enrollment, do not take effect until October. This year will be different due to the rapid changes regarding COVID-19. If you would like to make any changes to your health benefits, forms must be submitted to the benefits department via email to the Benefits Help Group or fax. All change forms and documents need to be received by the Benefits Department by June 12, 2020  If you have any questions please email the Benefits Help Group. Our fax number is
(831) 728-6996

Please do not go to American Fidelity regarding changing your health benefits. If you would like to sign up for any of the Voluntary products or Section 125 Benefits Plan Please fill out the Interest Form Or call American Fidelity at (925) 984-3599

Open enrollment forms

Medical Election Form 
You will need to fill out a new enrollment form depending on the plan you choose.

Dental Designation Form
If you are going from the PPO Only Non-Incentive Plan to a Premier Plan your coverage will start at 70% Coverage. 

Dental Plan Summary

SISC Membership Change Form
Add/Drop Dependent - If you are adding or dropping anyone you will need to provide the necessary documentation

SISC III Enrollment Form

  • PPO → HMO 
  • Kaiser → PPO or HMO

Kaiser Enrollment Form

  • PPO or HMO → Kaiser