Personnel Support Services - Benefits

Carin Freitas, Benefits Specialist, Phone: (858) 521-2800 ext. 2897, FAX: 858-485-1355 email: cfreitas@powayusd.com
Christine Gold, Insurance Benefits Technician email: cgold@powayusd.com

2016 AND 2017 INSURANCE INFORMATION

Open Enrollment is from Friday, Nov 4, 2016 through Friday, Nov 18, 2016

Remember that Opt Out members are required to opt out on an annual basis and must complete a 2017 Opt Out Option Form. Current Opt Out members will receive an individualized letter concerning changes in legislation along with the 2017 Opt Out Option Enrollment Form.
If you are a current Flexible Benefit Plan Participant or wish to participate in plan year 2017, you will need to complete the 2017 Flex Enrollment Form.

Need help?

Attend one of our Open Enrollment Help Sessions located at the District Office:

Friday November 4, 2016 3:00pm – 5:30pm Community Room West
Monday November 7, 2016 3:00pm – 6:00pm Community Room West
Tuesday November 8, 2016 3:00pm – 5:30pm Aztec Room, Personnel Dept.
Monday November 14, 2016 9:00am – 11:00am & 3:00pm – 6:00pm Aztec Room, Personnel Dept.
Friday November 18, 2016 9:00am – 12:00pm & 3:00pm – 6:00pm Community Room East & West

See 2016 Benefits and Insurance Forms for 2016 Insurance Claims


2017 INSURANCE FORMS

INSURANCE GUIDES/FORMS GROUP TYPE
EMPLOYEE BENEFITS INFORMATION GUIDE ACTIVE MEDICAL
EMPLOYEE BENEFITS INFORMATION GUIDE - COBRA ALL MEDICAL
EMPLOYEE BENEFITS INFORMATION GUIDE - RETIREE RETIREE MEDICAL
2017 BENEFITS ENROLLMENT FORM - ACTIVE EMPLOYEE ACTIVE MEDICAL
2017 BENEFITS ENROLLMENT FORM - RETIREE RETIREE MEDICAL
2017 FLEX ENROLLMENT FORM ACTIVE FLEX
OPT OUT OPTION FORM ACTIVE  
OPT OUT WAIVER FORM ACTIVE  
2017 PUSD DELTA DENTAL BENEFIT SUMMARY ALL DENTAL
2017 PUSD MES VISION SUMMARY ACTIVE VISION
THE STANDARD LIFE INSURANCE ENROLLMENT FORM ACTIVE LIFE
2017 PUSD AETNA AVN HMO SBC (Summary of Basic Coverage) ACTIVE MEDICAL
2017 PUSD AENTA AVN HMO SUPPLEMENTAL INFO ACTIVE MEDICAL
2017 PUSD AETNA AVN HMO SUMMARY (AETNA VALUE NETWORK) ACTIVE MEDICAL
2017 PUSD AETNA EPO SUMMARY (ELECT CHOICE) ACTIVE MEDICAL
2017 PUSD AETNA FULL NETWORK SBC ACTIVE MEDICAL
2017 PUSD AETNA FULL NETWORK SUPPLEMENTAL INFO ACTIVE MEDICAL
2017 PUSD AETNA FULL NETWORK HMO SUMMARY ACTIVE MEDICAL
2017 PUSD AETNA OAMC SBC ACTIVE MEDICAL
2017 PUSD AETNA OAMC SBC SUPPLEMENTAL INFO ACTIVE MEDICAL
2017 PUSD AETNA OAMC SUMMARY (OPEN ACCESS MANAGED CHOICE) ACTIVE MEDICAL
2017 PUSD KAISER PRINCIPAL BENEFITS SUMMARY ACTIVE MEDICAL
2017 PUSD KAISER CHIRO RIDER ACTIVE MEDICAL
2017 PUSD KAISER TRANDITIONAL PLAN SBC (Summary of Benefits & Coverage) ACTIVE MEDICAL
2017 PUSD KAISER SENIOR ADVANTAGE [KPSA] ENROLLMENT FORM SENIORS MEDICAL
2017 PUSD KAISER SENIOR ADVANTAGE [KPSA] BENEFIT SUMMARY SENIORS MEDICAL
2017 PUSD KAISER SENIOR ADVANTAGE [KPSA] DENTAL SUMMARY SENIORS DENTAL
DOMESTIC PARTNER FIDAVIAFT ACTIVE  
PAYROLL DEDUCTION CHANGE ACTIVE  
MES Claim Form ACTIVE EYE
Handicaped Child Attending Physicians Statement Form ACTIVE  
Request for Continuation of Medical Coverage ACTIVE  
MHS HO ACTIVE LIFE
Domestic Partner Agreement Form ACTIVE  
Dependent Day Care Provider Acknowledgement Form ACTIVE  
Optum RX Claim Reimbursement Form ACTIVE RX
Beneficiary Designation Form ACTIVE  
     
     
     

 

 

The Poway Unified School District (PUSD) is an equal opportunity employer/program and is committed to an active Nondiscrimination Program. PUSD prohibits discrimination, harassment, intimidation, and bullying based on actual or perceived ancestry, age, color, disability, gender, gender identity, gender expression, nationality, race or ethnicity, religion, sex, sexual orientation, or association with a person or a group with one or more of these actual or perceived characteristics. For more information, please contact the Title IX/Equity Compliance Officer, Associate Superintendent of Personnel Support Services, Poway Unified School District, 15250 Avenue of Science, San Diego, CA 92128-3406, 858-521-2800, extension 2761. View Annual Notification of Parents’/Students’ Rights | Annual Notification of Employees’ Rights

POWAY UNIFIED SCHOOL DISTRICT | 15250 Avenue of Science, San Diego, CA 92128 | (858) 521-2800