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Change Forms

Change Forms

SISC Membership Change Form (add or drop dependents, change of address, name, DOB, etc.) 
*Must have a qualifying event to add or drop dependents with proper documents. Please contact the Benefits Department regarding any questions.

Beneficiary Form -change life insurance beneficiary at any time.

Voluntary deduction Cancellation Form
Please  note if you have deductions that are coming out pre-taxed you will have to wait until the end of the plan year to cancel it.
Claim Forms

Claim Forms

Blue Shield of California
Claims mailing address:
P. O. Box 272540
Chico, CA   95927
(855) 256-9404
Anthem Select Blue Cross
Claims mailing address:
P. O. Box 60007
Los Angeles, CA 90060-0007
(800) 825-5541
Kaiser
Claims mailing address:
P.O. Box 261155
Plano TX 75026
(800) 392-8649
Navitus
Claims mailing address:
P. O. Box 272540
Chico, CA   95927
(800) 642-6155
Delta Dental
Claims mailing address:
P. O. Box 997330
Sacramento CA. 95899-7330
(866) 499-3001
VSP
Claims mailing address:
3333 Quality Drive
Rancho Cordova, CA   95670
(800) 877-7195
New Hire Paperwork

New Hire Paperwork

 
22-23 RATES
*Certificated/ Management employees working a 50-90% FTE have to pay a percentage of the full premium amount equivalent to your percentage leave.

Opt Out Form 
*Only for employees that are working an FTE less than 90%