District Benefits: Administrators, CMS Employees & Trustees

If you need to make changes to your health plan due to a qualifying event please contact Jim Firth in the Office of People, Culture and Talent at ext. 6101 or benefits@avc.edu.

• Your Open Enrollment window was August 1st through August 20th, 2025

PDF Health Plan Election Forms:

• 2025-2026 CMSA Health Plan Election Form
• 2025-2026 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 Employee Election Form
  WABE is Waiver of Active Benefits Enrollment
• 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: 

• 2025-26 CMSA Health Plan Matrix

CMSA Benefit Plans: 

• Blue Shield Enrollment Guide
• Blue Shield PPO: P021000 - 100-A 20 Rx 7-25 | Summary | SBC | Plan Document 
• Blue Shield PPO: P041000 - 100-C 20 Rx 200/10-35 | Summary | SBC | Plan Document 
• Blue Shield PPO: P011000 - 90-C 20 Rx 9-35 | Summary | SBC | Plan Document
• Blue Shield PPO: P031000 - 80-G 30 Rx 200/10-35 | Summary | SBC | Plan Document
• Blue Shield PPO: P061000 - HSA 1700 90% Rx 9-35 - Single | Summary | SBC | Plan Document
• Blue Shield PPO: P071000 - HSA 1700 90% Rx 9-35 - Family | Summary | SBC | Plan Document
• Anthem Blue Cross Platinum+: M215 - Primary Care Plan Rx 9-35 | Summary | SBC | Plan Document
• HSA $5,000 Two-Tier: P051001 - 70%, $5k/$10k Deductible, Rx 9-35 | Summary | SBC | Plan Document
• Kaiser Enrollment Guide
• Kaiser HMO: 234480-0027 - 100% OV 10 Rx 10 | Summary | SBC | Plan Document
• Kaiser HMO: 234480-0029 - 100% OV 30 Rx 10-30 (30 days) | Summary | SBC | Plan Document
• Navitus Plan Information
• Delta Dental: 7079 1390: DD 2000; C 100/1500 | Summary
• VSP: 2524/64253AMN: Signature Plan C 0 | Summary
• Mutual Of Omaha Group Life Insurance: G000AMP6-A001: Term Life plus AD&D

Contact Numbers:

SISC Customer Service Contacts