District Benefits: Faculty Regular Full-Time & Part-Time Employees
2024/2025 Health Benefits Open Enrollment is now open:
- Your Open Enrollment window is August 1st through August 20th, 2025
Online Health Plan Election Form:
Paper Health Plan Election Forms:
- 2025-2026 Faculty Health Plan Election Form
- 2025-2026 Faculty Couples Rate Health Plan Election Form: both spouses or Domestic Partners must be enrolled in a SISC Composite rate plan to qualify.
SISC Forms:
- SISC Membership Change Form
- SISC III Enrollment Form
- SISC Kaiser Enrollment Form
- SISC Digital Signature Instructions
- SISC WABE Employee Enrollment Form
- WABE is Waiver of Active Benefits Enrollment
- SISC HIPPA Notice of Privacy
- SISC COBRA Notice
- Notice: Medical Insurance Benefits Provided to Domestic Partners as Taxable Income
Faculty SISC Benefit Matrix:
Faculty Benefit Plans:
- Anthem Blue Cross Enrollment Guide
- Blue Cross PPO: 40463A - 100-A 20 Rx 5-20 | Summary | SBC | Plan Document
- Blue Cross PPO: 40463B - 100-B 20 Rx 200/10-35 | Summary | SBC | Plan Document
- Blue Cross PPO: 40463C - 80-C 20 Rx 5-20 | Summary | SBC | Plan Document
- Blue Cross PPO: 40463D - 80-K 30 Rx 9-35 | Summary | SBC | Plan Document
- HSA $5,000 Two-Tier: 70112B - 70%, $5k/$10k Deductible, Rx 9-35 | Summary | SBC | Plan Document
- Anthem Blue Cross Platinum+: M215 - Primary Care Plan 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: 234480-0028 - 100% OV 20 Rx 10-20 | Summary | SBC | Plan Document
- Navitus Plan Information
- Delta Dental 1: 7079 1300 - Incentive Plan DD 2000; Adult & Child Ortho 100/1500; 3rd Cleaning | Summary
- Delta Dental 2: 7079 1350 - PPO 1500 | Summary
- VSP: 2536/64253ACN - Signature C $5, 2nd Pair | Summary
- Mutual Of Omaha Group Life Insurance: G000AMP6-A002: Term Life plus AD&D
Contact Numbers
SISC Customer Service Contacts
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.