Retiree Health Insurance Information

  • Please see below sections for retiree health insurance forms, rates, and plan summaries. If you will be a new retiree this year and you are eligible for the Bridge program, please remember that there is a deadline to turn in your retiree bridge form to Risk Mgmt and your retirement form to HRD. Please refer to your classifications bargaining unit language for applicable deadlines. Open enrollment for retirees is in the month of July each year. Please make sure you keep your email address up to date with Risk Mgmt as this is how the open enrollment (and all communication) will be sent to you.

Benefits Summaries and Changes Effective 10/1/2021

Benefits Summaries for 2020-21


    Click here for a side by side comparison of the plans (NOT ACCURATE PRICING - SEE THE LINK BELOW FOR THE PREMIUM SHEET)

    Management/Confidential Premium Sheet

    Click here to view plan summaries for the following plans:

    • PPO Plan A
      Group #: 40465L (55-64 retiree)
    • PPO Plan B
      Group #: 40465M (55-64 retiree)
    • PPO Plan C
    • Group #: 40465N (55-64 retiree)
    • PPO Plan D
    • Group #: 40465P single, 40465Q family (55-64 retiree)
    • HMO Classic
    • Group #: 57AHCG (55-64 retiree), 57AHCH (65+ retiree)
    • Kaiser
      Group #: 231876-0113 (55-64 retiree)
      Group #: 231876-0113 $10 Senior Advantage Plan (65+ retiree)
    • Anthem/Blue Cross Medicare Supplemental Plans
      Group #: 4R005A
      Group #: 4R005G
    • VSP (Vision)
      Group # 2338131A
    • Delta Dental 
      Group # 7079-7148 (Standard Dental)
      Group # 7079-2154 (With Ortho)
    • PPO Anthem Blue Cross Companion Care 65+ (SISC Direct)
    • HMO Blue Shield Medicare Advantage 65+ (SISC Direct)
    • Kaiser Senior Advantage 65+ (SISC Direct)

Retiree Health Insurance Forms


    Use the following forms to notify the District you are retiring from the District, and wish to convert your active employee health insurance to a retiree plan. If you are eligible for the District's Bridge program there is an additional form (below) that must be turned in to Risk Mgmt by the deadline as noted in your classification's bargaining unit language. There is also an additional retirement form that must be turned in to HRD by that deadline. 


    If you need to change your address or you need to remove spouse/dependents please use the following forms. Please note, if you are removing a spouse/dependent outside of open enrollment you must provide proof of other coverage showing their name and the effective date and you must do so within 30 days of the effective date:

    If you are turning 65 and would like to enroll in one of the 65+ plans, please fill out and turn in the corresponding form along with a copy of your Medicare card showing enrollment in both parts A & B at least 45 days prior to the 1st of the month of your 65th birthday if you will remain enrolled in the plan. 

    • Blue Shield 65+ HMO Advantage Plan with Silver & Fit (HMO)
    • Companion Care Medicare Supplemental Plan w/ Silver & Fit (PPO)
    • Kaiser Senior Advantage Election Form (for IRP too)

    2021/2022 Retiree Open Enrollment Selection Forms (will be available in July 2021)

    • Management/Confidential Retiree Open Enrollment Selection Form