Retiree Health Plans
SISC Benefit Plans
Please select the applicable category below to review your health plan options and election forms.
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- Medicare Age Eligible Retirees - Classified, Auxiliary, and Management
When a retiree or spouse or registered domestic partner of record becomes eligible for Medicare, the eligible person must apply for Medicare Part A and B prior to the month they turn 65. Failure to enroll in Medicare Part A and B and provide Human Resources proof of enrollment prior to the month they turn 65 may be billed a surcharge in the amount of $1,250 per month until proof of enrollment is received.
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- Medical Plans
HMO Medical Plans and Enrollment Forms
- Kaiser Permanente Sr Advantage $10 (2 pers w/Medicare) Benefits Summary
- Kaiser Permanente Sr Advantage Enrollment Form (2 pers w/Medicare)
- Kaiser Permanente Sr Advantage Enrollment Form (1 pers w/Medicare)
- Kaiser Sr Advantage Benefit Summary
- Blue Shield 65 Plus Advantage Benefits Summary
- Enrollment Request For Blue Shield 65 (HMO) Employer Group Enrollment Form
- SISC III Enrollment Form for Blue Shield HMO Full Network
PPO Medical Plans and Enrollment Forms
- Blue Shield PPO EGWP 100A Benefits Summary
- SISC CompanionCare/PPO EGWP Rx Enrollment Form
- Companion Care Benefits Summary
- SISC CompanionCare/PPO EGWP Rx Enrollment Form
Prescription Coverage
Additional Information
- Dental Plans (Optional)
HMO Dental Plan
PPO Dental Plans
- Vision Plan (Optional)
- Medical Plans
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- Non-Medicare Age Eligible Retirees - Classified and Auxiliary
- Non-Medicare Eligible Classified and Auxiliary Plan Election Form (2024-25)
- Declination of Coverage for Retirees Form
- Dependent Verification Review Information
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- Medical Plans
HMO Medical Plans and Enrollment Forms
- Blue Shield Trio Benefits Summary
- SISC III Enrollment Form for Blue Shield
- Blue Shield Full Network Benefits Summary
- SISC III Enrollment Form for Blue Shield
- Kaiser Permanente $0; Rx $5-20 (30 Day) Benefits Summary
- Kaiser Permanente Enrollment Form
- Kaiser Permanente $15; Rx $5-20 (30 Day) Benefits Summary
- Kaiser Permanente Enrollment Form
PPO Medical Plans and Enrollment Forms
- Blue Shield 90G $20; Rx $5-20 (30 Day) Benefits Summary
- Blue Shield 100A $10; Rx $5-20 (30 Day) Benefits Summary
- Blue Shield 2-Tier Anchor Bronze Benefits Summary
- SISC III Enrollment Form for Blue Shield
- Companion Care Benefits Summary
Prescription Coverage
Additional Information
- Dental Plans (Optional)
HMO Dental Plan
PPO Dental Plans
- Vision Plan (Optional)
- Medical Plans
- Non-Medicare Age Eligible Retirees - Confidential and Management
- Non-Medicare Eligible Confidential and Management Plan Election Form (2024-25)
- Non-Medicare Eligible Executive Management Plan Election Form (2024-25)
- Declination of Coverage for Retirees Form
- Dependent Verification Review Information
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- Medical Plans
HMO Medical Plans and Enrollment Forms
- Blue Shield Trio Benefits Summary
- SISC III Enrollment Form for Blue Shield
- Blue Shield Full Network Benefits Summary
- SISC III Enrollment Form for Blue Shield
- Kaiser Permanente $15; Rx $5-20 (30 Day) Benefits Summary
- Kaiser Permanente Enrollment Form
PPO Medical Plans and Enrollment Forms
- Blue Shield 80G $20; Rx $5-20 (30 Day) Benefits Summary
- Blue Shield 90G $20; Rx $5-20 (30 Day) Benefits Summary
- Blue Shield 100A $10; Rx $5-20 (30 Day) Benefits Summary
- Blue Shield 2-Tier Anchor Bronze Benefits Summary
- SISC III Enrollment Form for Blue Shield
Prescription Coverage
Additional Information
- Dental Plans (Optional)
HMO Dental Plan
PPO Dental Plans
- Vision Plan (Optional)
- Medical Plans
- Medicare Age Eligible Retirees - Classified, Auxiliary, and Management
Programs Available to All SISC Retirees:
- Sliver & Fit Program – Blue Shield Companion Care, Blue Shield Sr. Advantage and KPSA 65+
- Tivity Fitness Your Way – Blue Shield 100A EGWP
