2012
Health Benefit Summary

2012
Dental Choices

2012 BENEFIT RATES BY BARGAINING UNIT

2012 HEALTH PLAN CHOOSER

HEALTH PLAN SEARCH BY ZIP CODE

2012 CalPERS Health Plan Design, Rate, & Benefit Changes Webinar

REMINDER!!!
Due to recent health care reform, dependent children can now be covered up to age 26
regardless of student, residency, or marital status.

DPA BENEFIT ADMINISTRATION MANUAL

2011 BENEFIT MONTHLY RATES
Be sure to look at the correct rate sheet for your Bargaining Unit.
You can complete the enrollment forms and mail or fax them to the HQ confidential fax at: 831-335-6714.

2011 COBRA RATES

Health Enrollment - Form HBD12
Used for Health Enrollments, Additions, or Deletions of
Employee and/or Dependents upon qualifying permitting event or Open Enrollment Period

Dental Enrollment - Form STD 692
Used for Dental Enrollments, Additions, or Deletions of
Employee and/or Dependents upon qualifying permitting event or Open Enrollment Period

Flex Elect Cash Enrollment Form
Used for Flex Cash Enrollments, Additions, or Deletions of
Employee and/or Dependents upon qualifying permitting event or Open Enrollment Period

Flex Elect Dependent Care/ Medical Reimbursement Enrollment Form
Used for Flex Dependent/Medical Reimbursement Enrollments,
Additions, or Deletions of Employee and/or Dependents upon qualifying
permitting event or Open Enrollment Period

Employee Action Request
Std. 686
Used for Address and Withholding Changes

Payroll Distribution Form
Used to designate whether you want your check/pay stub mailed
or if you wish to pick it up at Headquarters

Annual/Sick-Vacation Leave Form
Simple Explanation of Annual Leave or Sick/Vacation Leave
Excerpt from BU8 MOU ARTICLE 10 -LEAVES

PERS Beneficiary Designation
PERS-BSD-241
Used to designate the beneficiary who will receive employee's
CalPERS benefits in the event of an untimely demise.

Designation of Person
Authorized to Receive Warrants
Std. 243
Used to designate the beneficiary who will receive employee's
final warrant in the event of an untimely demise.

FFI Separation Packet

2011 Holiday Schedule

Respiratory Protection Program
The 2010 RPP Questionnaires have been mailed out to those permanent and limited term personnel
who are required to complete this information annually. Click here to learn more

DENTAL:

VISION: https://www.vsp.com/member/htmls/member_home.jsp

CAL PERS: http://www.calpers.ca.gov/

DEPT. OF PERSONNEL ADMINISTRATION: http://www.dpa.ca.gov/benefits/main.htm

TRAINING: www.czutraining.org

STATE COMPENSATION INSURANCE FUND: http://www.statefundca.com/

EMPLOYEE ASSISTANCE PROGRAM: https://www.mhn.com/member/start.do , Company Code is "soc"

SAVINGS PLUS PROGRAM: https://www.nrsservicecenter.com/iApp/ret/content/landing.do?Role=None&Site=SPPFORU

COLLEGE SAVINGS PLAN: http://www.scholarshare.com/

LONG TERM CARE: http://www.calpers.ca.gov/index.jsp?bc=/member/ltc/home.xml

THE WORK NUMBER FOR EVERYONE (To Verify Employment/Salary)
http://www.theworknumber.com/ Instructions

LINKS TO MEMORANDUMS OF UNDERSTANDING