District Benefits: Administrators, CMS Employees & Trustees
Note: If you need to make changes to your health plan due to a qualifying event please contact Jim Firth in Human Resources at ext. 6101 or benefits@avc.edu.
2023/2024 Online Open Enrollment:
- Your Open Enrollment window was August 7th through August 23rd, 2023.
Health Plan Election Form:
- 2023-2024 CMSA Health Plan Election Form
- 2023-2024 CMSA Couples Rate Health Plan Election Form: Both spouses or Domestic Partners must be on SISC Composite rates to qualify.
SISC Forms:
- SISC Membership Change Form
- SISC III Enrollment Form
- SISC Kaiser Enrollment Form
- SISC WABE Waiver of Coverage Form
- SISC Digital Signature Instructions
- SISC HIPPA Notice of Privacy
- SISC Cobra Notice
- Notice: Medical Insurance Benefits provided to Domestic Partners as Taxable Income
CMSA SISC Health Matrix:
CMSA Benefit Plan Summaries:
- Blue Shield Enrollment Guide
- Blue Shield PPO: P021000: 100-A 20 Rx 7-25
- Blue Shield PPO: P041000: 100-C 20 Rx 200/10-35
- Blue Shield PPO: P011000: 90-C 20 Rx 9-35
- Blue Shield PPO: P031000: 80-G 30 Rx 9-35
- HSA $5,000 Two-Tier: P051001: 70%, $5k/$10k Deductible, Rx 9-35
- Kaiser Enrollment Guide
- Kaiser HMO: 234480-0027 - 100% OV 10 Rx 10
- Kaiser HMO: 234480-0029 - 100% OV 30 Rx 10-30
- Navitus Plan Information
- Delta Dental: 7079 1390: DD 2000; C 100/1500
- VSP: 2978534A: Signature Plan C 0
- Mutual Of Omaha Group Life Insurance: G000AMP6-A001: Term and AD&D
Contact Numbers:
SISC Customer Service Contacts