Personnel Forms & Resources
Personnel Forms & Resources
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Certificated Health Insurance Plan Summaries:
Anthem Blue Cross PPO 100A $0 Rx 7-25
Anthem Blue Cross PPO 100D $20 Rx 200 10-35
Anthem Blue Cross PPO 80G $20; Rx 200 10-35
Anthem Blue Cross HSA 3400 Rx HSA 3400
Anthem Blue Cross 2 Tier HSA 5000 Rx HSA 5000
SISC Proactive Care Plan Platinum Rx 9-35 PC
Anthem Dental PPO 4000; A 2000
Delta Dental Premier (Incentive) DD 2000; A 100 1000
Vision Service Plan Signature B $10
Classified Health Insurance Plan Summaries:
Blue Shield PPO 90A $10; Rx 5-20
Blue Shield PPO 80C $20; Rx 5-20
Blue Shield PPO 80G $30; Rx 9-35
Blue Shield PPO HSA 1700; Rx HSA 1700
Blue Shield PPO 2-Tier HSA 5000; Rx HSA 5000
SISC Proactive Care Platinum; Rx 9-35 PC
Anthem Dental PPO 4000; A 2000
Delta Dental Premier (Incentive) DD 2000; A 100 1000
Delta Dental PPO 1500; A 100 1000
Vision Service Plan Signature B $10
Management/Confidential Health Insurance Plan Summaries:
Anthem Blue Cross PPO 100A $0 Rx 7-25
Anthem Blue Cross PPO 100D $20 Rx 200 10-35
Anthem Blue Cross PPO 80G $20; Rx 200 10-35
Anthem Blue Cross HSA 3400 Rx HSA 3400
Anthem Blue Cross 2 Tier HSA 5000 Rx HSA 5000
SISC Proactive Care Plan Platinum Rx 9-35 PC
Anthem Dental PPO 4000; A 2000
Delta Dental Premier (Incentive) DD 2000; A 100 1000
Vision Service Plan Signature B $10
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