Anthem Blue Cross PPO Enrollment Guide

New Hires

Certificated: Certificated New Hire Packet - Effective October 2022

Classified: Classified New Hire Packet - Effective October 2022

AD&D (Accidental Death & Dismemberment)

Sign Up for Voluntary AD&D Insurance: Mutual of Omaha Voluntary Enrollment Form

AD&D and Life Insurance Overview: Basic Life/AD&D Handbook

Open Enrollment

For both Certificated/Classified New Hires: Instructions to Calculate Monthly Deduction

Certificated, Confidential, & Certificated/Classified Management Employees:

• Health Plans for Certificated/Confidential/Management Employees
• Monthly Deduction Calculation Form for Certificated, Confidential, & Management Employees

Classified Employees:

• Health Plans for Classified Employees
• Monthly Deduction Calculation Form for Classified Employees

Six-Hour Classified Employees:

• Enrollment Form for SISC Bronze Health Plan
• Enrollment Form for Basic Life/AD&D Insurance
• OPTIONAL - Enrollment Form for CSEA MetLife Dental Insurance
• OPTIONAL - Enrollment Form for CSEA Vision Insurance

Substitutes & Less-Than-Six-Hour Employees:

• Form to Accept/Decline Minimum PPO Medical Plan Offer (Please complete regardless if you are electing or waiving coverage)

Change in Benefits

Qualifying Life Event (Marriage, Birth, Adoption, Divorce, or Death): SISC Membership Change Form

Determine Necessary Supporting Documents: Dependent Eligibility Documentation Chart

Change Basic Life/Voluntary Life Insurance Beneficiary: SISC Basic Life Beneficiary Change Form

Upon Death Designation Form: Designation of Person to Receive Warrants/Checks Form