Pajaro Valley USD

Departments

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. Employees have 30 days from the date of the qualifying event to turn in any paperwork and supporting 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.

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Departments

Business Services

Benefits

Forms

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

Disabled Dependent Form

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%

Affidavits

Marriage

Domestic

Partner Registry

American Fidelity Assurance