District Benefits: Classified Employees
Note: If you need to make changes to your health plan due to a qualifying event please contact Jim Firth in Human Resources at ext. 6101 or benefits@avc.edu.
2023/2024 Online Open Enrollment:
- Your Open Enrollment window was August 7th through August 23rd, 2023.
Health Plan Election Form:
- 2023-2024 Classified Health Plan Election Form
- 2023-2024 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 Waiver of Coverage Form
- SISC HIPAA 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
- Blue Cross PPO: 40011B - 100-B 20 Rx 9-35
- Blue Cross PPO: 40011C - 90-A 20 Rx 9-35
- Blue Cross PPO: 40011E - 80-G 30 Rx 9-35
- HSA $5,000 Two-Tier: 70111B - 70%, $5k/$10k Deductible, Rx 9-35
- Kaiser Enrollment Guide
- Kaiser HMO: 244380-0027 - 100% OV 10 Rx 10
- Kaiser HMO: 244380-0028 - 100% OV 20 Rx 10-20
- Navitus Plan Information
- Delta Dental: 7079 1290 - DD 2000; C 100/1500
- VSP: 3237464A - Signature C $0; 2nd pair glasses
Contact Numbers