Payroll / Insurance: Retirees <65 OR COBRA

Retiree Cancellation Request form
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Use this form to cancel one or all District insurance plans. If you are keeping your coverage but cancelling a dependent's health insurance, you must use the SISC membership change form. http://sisc.kern.org/hw/ under Forms & Notices

RETIREE.cancellation request.interactive.doc, 824.50 KB (Last Modified on December 3, 2012 )

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Blue Cross Contact Information
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Anthem Blue Cross

1-800-322-5709

www.anthem.com/ca/sisc

, (Last Modified on April 5, 2011 )

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CalsTrs Benefit Counselor
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John Murphy

CalsTrs Benefit Counselor

402 Farnel Road, Suite B

Santa Maria, CA 93454

Phone: 805-928-0542

, (Last Modified on May 3, 2011 )

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Delta Dental Plan Overview
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Brief Description of Plan Benefits for more comprehensive information visit www.deltadental.com or call 1-888-335-8227

Delta_Dental_Plan_Details.pdf, 36.93 KB (Last Modified on April 5, 2011 )

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Delta Dental Enrollment Form (For Retirees/COBRA)
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Dental enrollment form for both Retirees and COBRA enrollees.

Delta_Dental.pdf, 71.67 KB (Last Modified on March 31, 2011 )

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Insurance Payment & Cancellation Policy
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payment.cancellation.policy.pdf, 61.96 KB (Last Modified on April 5, 2011 )

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Retiree HMO Enrollment Form
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RETIREE_CALIF_CARE_HMO_APP.pdf, 108.26 KB (Last Modified on March 29, 2011 )

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Retiree PPO Enrollment Form
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Enrollment form for both 80% and Base Plan

PPOenrollmentpvAug2010.pdf, (Last Modified on March 31, 2011 )

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VSP Plan Overview (for Retirees/COBRA)
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Brief description of vision plan benefits. This plan is only available for 18 months. For more comprehensive information visit www.vsp.com or call 1-800-877-7195

VSP_Brochure.pdf, (Last Modified on April 6, 2011 )

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LUSD has established a uniform complaint procedure (1312.3) for all relevant programs per 5 CCR § 4622 et seq . The district has a policy of nondiscrimination on the basis of gender per Education Amendments of 1972, Title IX: Nondiscrimination.

Retiree Cancellation Request form

Blue Cross Contact Information

CalsTrs Benefit Counselor

Delta Dental Plan Overview

Delta Dental Enrollment Form (For Retirees/COBRA)

Insurance Payment & Cancellation Policy

Retiree HMO Enrollment Form

Retiree PPO Enrollment Form

VSP Plan Overview (for Retirees/COBRA)