Employee Benefits

Open Enrollment Forms – 2021

OE Flyer 2021
Insurance Rate Sheet 2021
Special District Life Insurance Form 2021 – fillable
SD Open Enrollment Election Form 2021-fillable
Special District Open Enrollment Form 2021 – fillable
SD Prudential EOI Short Form
SETA-Life-Insurance-Beneficiary_Fillable
Waiver Form 2021 – Special District – Fillable
Optum_HSA_Employee_Contribution_Election_Form 9.30.20
Health Equity_HSA_Employee_Contribution_Election_Form 9.30.20 (002)
ICMA 457ContributionChangeForm 2020
Address-Name-Change-Packet
Special District Summary 2021 final 9_16_2020
2021 CHIP Notice
2021 Creditable Non Creditable Coverage Notice
2021 Marketplace Notice

Special Financial Workshops — November 2020

Employer Groups_ OCTOBER_NOVEMBER SFS Webinars

Benefits Information

Insurance Rate Sheet 2020
Special District Summary 2020
Covered California Notice 2020
Notice of Privacy Practices
CHIP Notice
SCERS
Employee Assistance Program (EAP)
Understanding Health Savings Accounts (HSAs)

Enrollment Forms

Special District Enrollment Form 2020
Optum HSA Employee Contribution Election Form
Health Equity HSA Employee Contribution Election Form
SETA Life Insurance
SETA Life Insurance Beneficiary Designation Form

Summary of Benefits and Coverage

Kaiser HMO SBC – 2020
Kaiser HDHP SBC – 2020
Sutter HMO SBC – 2020
Sutter HDHP SBC – 2020
WHA HMO SBC – 2020
WHA HDHP SBC – 2020 (Employee Only)
WHA HDHP SBC – 2020 (Family)

ICMA 457 Retirement Plan

ICMA 457 Retirement Plan
ICMA-RC (Retirement Savings Plan) Website
Video:Who’s in Charge of Your Retirement? Get to Know Your 457 Plan
Video: Get Reimbursed for Health-Care Costs-Your Retirement Health Savings (RHS) Plan
Video: ICMA-RC Will Continue to Work for You
Video: Su Plan De Remuneracion Diferida 457

NEW ICMA FEATURE!!! Quick and Easy Online Mobile Enrollment
Mobile Enrollment Overview for Employees
Online Enrollment at a Glance