All forms open in a view-only format and can be printed and filled out. If you are unable to open these forms, you can download adobe acrobat reader here:

General

Any and ALL forms MUST be returned to the Risk Managment Office for proper processing.

Student certification, newly eligible dependents and terminating dependents will require additional documentation. This may include a copy of transcripts, birth certificates, marriage certificates, divorce decrees or other legal documentation.

(Please note these forms may take several minutes to download)

Medical Plans

Blue Shield: (please note these forms may take several minutes to download)

1. Enrollment Form
2. Change Form
3. Claim Form
4. COBRA Form
5. Declaration of Disability Overage Dependent Form
6. Domestic Partner Form

CIGNA:

1. Enrollment Form
2. Change Form
3. Claim Form - Medical
4. Claim Form - Pharmacy
5. ID Card Request
6. Student Certification Form
7. Domestic Partner Form

Kaiser:

1. Enrollment Form
2. Change Form
3. Student Certification Form
4. Domestic Partner Form

Dental Plans

Delta Premier:

1. Enrollment/Change Form
2. Claim Form
3. Domestic Partner Form

DeltaCare PMI:

1. Enrollment/Change Form
2. Domestic Partner Form

Vision Plan

VSP:

Enrollment/change forms are not required for this plan. The District automatically enrolls you based on your medical plan selection.

Life Insurance

Blue Shield Life and Health:

1. Enrollment Form
2. Beneficiary Change Request Form