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Change Forms
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.
*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.
Forms
Claim Forms
Claim Forms![]()
Claim Forms
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Anthem Select Blue Cross
Claims mailing address: P. O. Box 60007
Los Angeles, CA 90060-0007 (800) 825-5541 |
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New Hire Paperwork
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. |