District Benefits: Classified Employees
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 Classified Health Plan Election Form
- 2025-2026 Classified 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 Enrollment Form
- SISC Kaiser Enrollment Form
- SISC Digital Signature Instructions
- SISC WABE Employee Election 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
Classified SISC Health Matrix:
Classified Benefit Plans:
- Anthem Blue Cross Enrollment Guide
- Blue Cross PPO: 40011A - 100-A 20 Rx 7-25 | Summary | SBC | Plan Document
- Blue Cross PPO: 40011B - 100-B 20 Rx 9-35 | Summary | SBC | Plan Document
- Blue Cross PPO: 40011C - 90-A 20 Rx 9-35 | Summary | SBC | Plan Document
- Blue Cross PPO: 40011E - 80-G 30 Rx 9-35 | Summary | SBC | Plan Document
- HSA $5,000 Two-Tier: 70111B - 70%, $5k/$10k Deductible, Rx 9-35 | Summary | SBC | Plan Document
- Blue Cross Platinum+: M215 - Primary Care Plan Rx 9-35 | Summary | SBC | Plan Document
- Kaiser Enrollment Guide
- Kaiser HMO: 244380-0027 - 100% OV 10 Rx 10 | Summary | SBC | Plan Document
- Kaiser HMO: 244380-0028 - 100% OV 20 Rx 10-20 | Summary | SBC | Plan Document
- Navitus Plan Information
- Delta Dental: 7079 1290 - DD 2000; A 100/1500 | Summary
- VSP: 2523/64253ALN - Signature C $0; 2nd pair glasses | 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.