District Benefits: Faculty Regular Full-Time & Part-Time Employees
Hard Copy Health Plan Election Form:
2026-2027 Faculty 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 Digital Signature Instructions
- SISC WABE Employee Enrollment Form
- WABE is Waiver of Active Benefits Enrollment (now includes Dental and Vision)
- SISC HIPPA Notice of Privacy
- SISC COBRA Notice
- Notice: Medical Insurance Benefits Provided to Domestic Partners as Taxable Income
Faculty SISC Benefit Matrix:
- The 2026-2027 Faculty Benefit Matrix is page two of the HPEF located here
Faculty Benefit Plans:
- Anthem Blue Cross Enrollment Guide
- Blue Cross PPO: 40463A - 100-A $20 Rx 5-20 | Summary | SBC | Plan Document
- Blue Cross PPO: 40463B - 100-B $20 Rx 200/10-35 | Summary | SBC | Plan Document
- Blue Cross PPO: 40463C - 80-C $20 Rx 5-20 | Summary | SBC | Plan Document
- Blue Cross PPO: 40463D - 80-K $30 Rx 9-35 | Summary | SBC | Plan Document
- HSA $5,000 Two-Tier: 70112B - 70%, $5k/$10k Deductible, Rx 9-35 | Summary | SBC | Plan Document
- Anthem Blue Cross Diamond: M215 - Primary Care Plan 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: 234480-0028 - 100% OV $20 Rx 10-20 | Summary | SBC | Plan Document
- Navitus Plan Information
- Delta Dental 1: 7079 1300 - Incentive Plan DD 2000; Adult & Child Ortho 100/1500; 3rd Cleaning | Summary
- Delta Dental 2: 7079 1350 - PPO 1500 | Summary
- VSP: 2536/64253ACN - Signature C $5, 2nd Pair | Summary
- Mutual Of Omaha Group Life Insurance: G000AMP6-A002: Term Life plus AD&D
Contact Numbers
SISC Customer Service Contacts