Open Enrollment for Retirees medical insurance is from August 1-August 31

• During Open Enrollment, you select your benefits from October 1, 2025, through September 30, 2026.
• Changes you make go into effect on October 1, 2025

Open Enrollment for dental insurance is once every three years (the dental open enrollment is happening in 2027).

Open Enrollment is your once-a-year opportunity for retirees to review current benefit elections and make changes such as:

• Change medical plans
• Drop medical plan
• Add or drop dependents

After Open Enrollment ends, you cannot change your benefit elections until the next Open Enrollment, unless you have a ‘qualified status change’.

If you aren't making any changes to your Health Insurance, then no action is required. 

• Retiree benefit summaries and rates

  The District offers a choice of five medical plans through our membership in Self-Insured Schools of California (SISC). These rates are for Retirees and are effective October 1, 2025:

  Rates for self payers not on ERO and those over 65

  Rates for ERO - Classified, Faculty

  Rates for ERO - Management 

   

   

  Please click on the links below to view the Benefit Summaries of the five medical 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.

  Anthem CompanionCare - Medicare Supplement plan

  Kaiser Senior Advantage - Medicare Advantage plan

   

  Medicare Part D Notice

  Blue Shield drug formularies and doctor search

   

• Retiree 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:

  FOR RETIREES UNDER AGE 65:

  Membership Change form

  Making changes to your current medical plan (like adding or deleting a dependent)? Please fill out the Membership Change form.

   

  Blue Shield enrollment form

  Use this 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 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:
      • Click on “Primary Care Physician”
      • Type in your location
      • Select Specialty, like “Family Practice”, “Internal Medicine”, etc.

   

  Kaiser enrollment form

  Use this form to enroll for the first time and follow these instructions: 

                           * Be sure to check "HMO" or "Deductible plan" in Section A on the enrollment form

   

   

  FOR RETIREES OVER AGE 65:

  Kaiser Senior Advantage enrollment form

   

  Anthem CompanionCare enrollment form

   

  To waive your medical insurance, please contact Christie Colón in Human Resources at ccolon@santarosa.edu or 707-527-4304.