Affordable Care Act
The District offers a choice of five medical plans through our membership in Self-Insured Schools of California (SISC). The medical plans meet the Affordable Care Act (ACA) requirements for affordable minimum essential coverage that provides minimum value for full-time employees. Please click on the links below to view the Benefit Summaries of these five plans:
- Kaiser Permanente HMO
- Kaiser Permanente Deductible plan with a Health Savings Account (HSA). This is a HMO deductible plan
- Blue Shield of California HMO
- Blue Shield of California PPO
- Blue Shield of California PPO Deductible plan with a Health Savings Account (HSA). This is a PPO deductible plan.
ENROLLMENT FORMS:
All enrollment forms should be submitted to Christie Colón in Human Resources.
Don't forget to provide the dependent eligibility documentation if you're adding a dependent.
These forms are fillable and signable. Once you've opened the form, please click "Download" to download the signable version.
BLUE SHIELD ENROLLMENT FORM
Use this Blue Shield enrollment form to enroll for the first time and follow these instructions:
Blue Shield PPO or HSA – you must write HSA or PPO in the top margin on the form
Blue Shield HMO – you must select a doctor when enrolling in this plan and include the doctor's IPA & PCP information on the enrollment form:
- IPA is the Medical Network/Group Name
- PCP is the Primary Care Physician #
Here’s how to search on Blue Shield's website for the IPA and PCP information and to select a Blue Shield HMO doctor in your area:
Search Blue Shield HMO Doctors in your area
- Click on “Primary Care Physician”
- Type in your location
- Select Specialty, like “Family Practice”, “Internal Medicine”, etc.
- Next to the doctor's name you'll see the medical network they belong to - you'll need to enter that in the "IPA" field on the enrollment form.
- Click on the doctor's name and you'll find the Primary Care Physician ID (PCP) that you'll need to enter on the enrollment form.
KAISER ENROLLMENT FORM
Use this Kaiser enrollment form to enroll for the first time and follow these instructions:
* Be sure to check "HMO" or "Deductible plan" in Section A on enrollment form