Retiree Benefits

Auxiliary and Classified (non-medicare)

Welcome to the retiree benefits page for auxiliary and classified employees under the age of 65. Here you will find information about the health and wellness benefits available to you in retirement. Our goal is to help you understand your options and make the best choices for your needs as you enter this new stage of life.

- Election Forms
  New Plan Year - Effective October 1, 2025
  - Non-Medicare Eligible Classified and Auxiliary Plan Election Form (2025-26)
  Additional Forms
  - Declination of Coverage for Retirees Form
  - Dependent Eligibility Documentation Checklist
- Medical Plans
  HMO Medical Plans
  
  Kaiser Benefit Summaries (HMO)
  - Kaiser Permanente $15; Rx $5-20 (30 Day) (2025-26)
  - Kaiser Permanente $0; Rx $5-20 (30 Day) (2025-26)
  Kaiser Enrollment Form (HMO)
  - Kaiser Permanente Enrollment Form
  Blue Shield Benefit Summaries (HMO)
  - Blue Shield Trio (2025-26)
  - Blue Shield Access+ Full Network (2025-26)
  Blue Shield Enrollment Form (HMO)
  - SISC III Enrollment Form for Blue Shield
  PPO Medical Plans
  
  Blue Shield Benefit Summaries (HMO)
  - Blue Shield 90G $20; Rx $5-20 (30 Day)
  - Blue Shield 100A $10; Rx $5-20 (30 Day)
  Blue Shield Enrollment Form (HMO)
  - SISC III Enrollment Form for Blue Shield
  Prescription Coverage
  - Navitus Medicare Rx Information
  Additional Information
  - HIPAA Notice of Privacy Practices
- Dental Plans (Optional)
  HMO Dental Plan
  - Delta Care USA
  PPO Dental Plans
  - Delta Dental 1500
  - Delta Dental Incentive Unlimited
- Vision Plan (Optional)
  - VSP Signature Plan C $0

Retiree Benefits

Auxiliary and Classified (non-medicare)

HMO Medical Plans

PPO Medical Plans

Prescription Coverage

Additional Information

HMO Dental Plan

PPO Dental Plans