District Benefits: Faculty-Adjunct Employees
Benefits are only available to qualifying Faculty-Adjunct during Open Enrollment.
The Fall 2020 Open Enrollment window is August 8, through August 25.
We are encouraging every qualified employee (**see below) to use the new online Open Enrollment Form this year. This form is a quick and easy way for you to select your benefits for the 2020/2021 benefit year. Most employees will not need to submit other documentation.
**In accordance with the terms of the collective bargaining agreement between the AVCFT and Antelope Valley College, Article IX, section 18.104.22.168: The District will pay 50% of the premium for any of the health insurance programs (medical ONLY) for adjunct faculty who have no other access to medical insurance and who are working at least 6.0 LHE or the equivalent load for non-classroom adjunct faculty (40% of full-time load).
Health Plan Election Form:
- 2020-2021 Adjunct Health Plan Election Form
- For your reference only: 2019-2020 Adjunct Health Plan Election Form
- SISC Membership Change Form
- SISC III Enrollment Form
- SISC Kaiser Form
- SISC Digital Signature Instructions
- SISC HIPPA Notice of Privacy
- SISC COBRA Notice
- Notice: Medical Insurance Benefits Provided to Domestic Partners as Taxable Income
- Domestic Partnership Affidavit Termination
Faculty Health Matrix:
Faculty Benefit Plans:
- Blue Cross PPO: 40463A - 100-A 20 Rx 5-20
- Blue Cross PPO: 40463B - 100-B 20 Rx 5-20
- Blue Cross PPO: 40463C - 80-C 20 Rx 5-20
- Blue Cross PPO: 40463D - 80-K 30 Rx 9-35
- Kaiser HMO: 225543-1018 - OV 10 Rx 10
- Kaiser HMO: 225543-1019 - OV 20 Rx 10-20
- Navitus Plan Information
- Delta Dental 1: 7079 1300 - DD 2000; C 100/1500
- Delta Dental 2: 7079 1350 - PPO 1500
- VSP: 2606681A - Signature C 5
Note: If you need to make changes to your health plan due to a qualifying event please contact Jim Firth, Human Resources Technician Benefits at ext. 6101 or email@example.com.