District Benefits: Administrators, CMS Employees & Trustees
2025/2026 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 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:
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
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.