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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.

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

 

Affidavits
Marriage

Domestic
Partner

Certificated

Classified

 

American Fidelity Assurance