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. 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

Benefits Enrollment Packet

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