Personnel Services

Current Employees

• Active Employee Enrollment Form
• Special District Employee Enrollment Form
• Waiver of Employer Coverage Affidavit - 2020
• Waiver of Employer Coverage Affidavit - 2019
• Active 2020 MyBenefits Summary
• Active 2019 MyBenefits Summary
• Special District 2020 MyBenefits Summary
• Special District 2019 MyBenefits Summary
• Frequently Asked Questions regarding benefits
• Same Sex Spouse Q&A
• Life Event Enrollment Instructions​
• Benefits Packet for New Hires
• New Hire Plan Details
  
• New Employee Checklist
• Notice of Privacy Practices
• Creditable/Non Creditable Notice
• CHIP Notice
• Covered California Notice

Kaiser Permanente (KP)

• Evidence of Coverage
• HMO Evidence of Coverage - Chiropractic Services
• Kaiser HMO SBC - 2020

• Kaiser HDHP HMO SBC - 2020

• ​​​​Understanding Your Costs​
• FAQ about Cost Estimates
• Sample Fee List
• Preventative Services
• Paying for Care
• Right Care Right Place
• Mobile Connected to Better Health
• HSA Plan Presentation
• HSA Plan Tips
• HSA Plan FAQ
• Mental Health

 Sutter Health Plus (SHP)

• HMO Evidence of Coverage
• Sutter HMO SBC - 2020
• High Deductible HMO Evidence of Coverage
• Sutter HDHP HMO SBC - 2020
• Sutter Sample Fee Schedule
• Evidence of Coverage - Infertility Rider
• Statement of Benefits - Acupuncture & Chiropractic​​
  
• Great Coverage Book
• My Health On Line
• Portal Flyer
• Travel Flyer
• Behavioral Health Flyer
• Same Day Care
• PCP Flyer
• Video Visit
• Walk In Care
• In Your Community - Sacramento
• Wellness
• Pharmacy
• Preventive Care

Western Health Advantage (WHA) 

• Evidence of Coverage
• WHA HMO SBC - 2020
• Infertility Benefit
  
• WHA HDHP HMO SBC - 2020
• Employee only
• Family
• WHA Preventative Services
• My WHA Wellness Flyer
• MHP Notification
• Continuity of Care Form
• Manage Your HDHP
• Urgent Care
• Emergency Preparedness Resources
• Telehealth

Vision Service Plan (VSP) 

• VSP Vision Care
• Extra $20 Coupon
• Hearing Aid Discount - TruHearing
• The Importance of an Eye Exam
• Eyeconic Overview with Benefit Integration

Health Savings Accounts (HSA)

• HSA Authorization Form
  
• Optum Designation of Beneficiary
  
• Optum Rollover Form
• Health Equity HSA Rollover Form
• Health Equity HSA Beneficiary Designation

Flexible Spending Accounts (FSA)

• FSA Claim Form
• Day Care Reimbursement Claim Form
• Orthondontia Reimbursement Claim Form
• Flex Plan Summary​

Delta Dental (Dental)

• Employee Dental Plan booklet
• Go Paperless
• Find a Network Dentist
• Estimate Your Cost
• SmileWay Benefit
• Where's My ID Card
• Stay Connected
• National Nutrition Month

Life Insurance

• Your Group Life Insurance Certificate of Coverage
• Life Insurance Change Form (Actives)
• Life Insurance Beneficiary Designation
• Life Insurance Short Form - For Increases 
• Conversion Rates
• Conversion Notice 
• SETA Life Insurance Form
• Life Insurance Form non-SETA​
• Group Insurance Coronavirus (COVID-19) FAQ

Critical Illness

• Critical Illness Certificate of Coverage
• Critical Illness Application
• Critical Illness Health Statement Questionnaire
• Critical Illness - Summary
• Critical Illness - FAQ
  

Employee Assistance Program (EAP)

• FAQs Regarding Care Coordination
• Value of Your EAP
• Momentum Flyer
  
• Financial Wellness
• Telehealth Services
• Lifemart Discount Center
• Military Resources
• March Tax Flyer
• Coping with Stress During Infectious Disease Outbreaks
• EAP Resources
• Maintain Your Recovery During the Pandemic
• Twitter Chat Series
• How to Safeguard Your Mental Health while Quarantined
• May Newsletter
• How to cope with the stress and trauma of the COVID pandemic
• The loss of normalcy: coping with grief and uncertainty during COVID-19
• Essential workers: Safety at work and home
• Legal/Financial/ID Theft resources
• Preparing for crisis
• Practicing compassion

Retiree Health Savings Plan (RHSP)

• Retiree Health Savings Plan Document
• Performance Analysis
• Q&A
• Employee Change Form​

Long-Term Care

• CalPERS Long-Term Care Program Overview
• CalPERS Long-Term Care Program FAQ
• CalPERS Long-Term Care Program Flyer 

529 College Savings Plan

• Direct Deposit Allocation Form​
  

Retirees

• Retiree 2020 MyBenefits Summary
• Retiree 2019 MyBenefits Summary
• Retiree Enrollment Form
• Retiree Medical Administrative Policy
• Retiree Summary Flow Chart

Medicare Enrollment Forms

(Required in addition to the County form when enrolling in or switching between a Medicare Plan)

• Kaiser Senior Advantage Application

Medicare Disenrollment Forms

(Required in addition to the County form when dis-enrolling from or switching between a Medicare plan) 

• Kaiser Senior Advantage Disenrollment Form 

Kaiser Permanente (KP)

• Evidence of Coverage
• Kaiser HMO SBC - 2019
• Kaiser HDHP HMO SBC - 2020

• Evidence of Coverage - Retiree Chiropractic Rider
  
• ​​​​Understanding Your Costs​
• FAQ about Cost Estimates
• Sample Fee List
• Preventative Services​
• Paying for Care
• Right Care Right Place
• Mobile Connected to Better Health
  
• HSA Plan Presentation
• HSA Plan Tips​
• HSA Plan FAQ
• Mental Health

Sutter Health Plus (SHP)

• HMO Evidence of Coverage
• Sutter HMO SBC - 2020
• High Deductible HMO Evidence of Coverage     
• Sutter HDHP HMO SBC - 2020
• Sutter  Sample Fee Schedule
• Evidence of Coverage - Infertility Rider     
• Statement of Benefits - Acupuncture & Chiropractic​​​
  
• Great Coverage Book
• My Health On Line
• Portal Flyer
• Travel Flyer
• Behavioral Health Flyer
• Same Day Care
• PCP Flyer
• Video Visit
• Walk In Care
• In Your Community - Sacramento
• Wellness
• Pharmacy
• Preventive Care

United HealthCare (UHC)

• HMO Evidence of Coverage (2020)
• PPO Evidence of Coverage (2020)
• HMO Evidence of Coverage (2019)​
  
• PPO Evidence of Cover​age (2019)
  
• HouseCalls
  

Western Health Advantage (WHA)

• Evidence of Coverage
• WHA HMO SBC - 2020
• Infertility Benefit
• WHA HDHP HMO SBC - 2020
• Employee only
• Family
• WHA Preventative Services
• My WHA Wellness Flyer
• MHP Notification
• Continuity of Care Form
• Manage Your HDHP
• Urgent Care
• Emergency Preparedness Resources
• Telehealth

Vision Service Plan (VSP) 

• VSP Vision Care
• Extra $20 Coupon
• Hearing Aid Discount - TruHearing
• The Importance of an Eye Exam
• Eyeconic Overview with Benefit Integration

Principal Financial (DENTAL)

• Retiree Dental POS Benefit Summary
• Principal Dental Evidence of Coverage
• Understand Your Benefits
• Discount Services
• Locating a Network Provider
• Making Informed Decisions
• Mobile App
• Provider Referral
• Understanding EOB
• Understanding POS 

Retiree Health Savings Plan (RHSP)

• Claim Form
• Eligibility Form
• Direct Deposit Authorization Form
• Decedent Information Form
• Q&A

Long-Term Care

• CalPERS Long-Term Care Program Overview
• CalPERS Long-Term Care Program FAQ
• CalPERS Long-Term Care Program Flyer