District Benefits: Faculty Regular Full-Time & Part-Time Employees
Note: If you need to make changes due to a qualifying life 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 Faculty Health Plan Election Form
- 2023-2024 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 Waiver of Benefits Form
- 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
- Blue Cross PPO: 40463B - 100-B 20 Rx 200/10-35
- Blue Cross PPO: 40463C - 80-C 20 Rx 5-20
- Blue Cross PPO: 40463D - 80-K 30 Rx 9-35
- HSA $5,000 Two-Tier: 70112B - 70%, $5k/$10k Deductible, Rx 9-35
- Kaiser Enrollment Guide
- Kaiser HMO: 234480-0027 - 100% OV 10 Rx 10
- Kaiser HMO: 234480-0028 - 100% OV 20 Rx 10-20
- Navitus Plan Information
- Delta Dental 1: 7079 1300 - DD 2000; C 100/1500; 3rd Cleaning
- Delta Dental 2: 7079 1350 - PPO 1500
- VSP: 2606681A - Signature C $5, 2nd Pair
Contact Numbers