NEW RETIREES

Use the following forms to notify the District you are retiring from the District, and wish to convert your active employee health insurance to a retiree plan. If you are eligible for the District's Bridge program there is an additional form (below) that must be turned in to Risk Mgmt by the deadline as noted in your classification's bargaining unit language. There is also an additional retirement form that must be turned in to HRD by that deadline. 

• Certificated Retiree Initial Selection Form
• 2019/2020 TVEA Retiree Medical Bridge Program Form 
• Management/Confidential Retiree Initial Selection Form
• MGMT/CONF Retiree Bridge Form
• Classified Retiree Initial Selection Form 
• 2019/2020 CSEA Retiree Bridge Medical Program Form

If you are a Certificated 65+ retiree and you would like to enroll in one of SISC's Individual Retiree Plans (IRPs) you must also fill out one of the following forms (based on which IRP you choose). These forms MUST be turned in to Risk Mgmt along with a copy of your Medicare card showing enrollment in both parts A & B AT LEAST 45 days in advance of the 1st of the month of your 65th birthday or upon enrollment if already 65 upon retirement:

• Companioncare Medicare Supplemental Plan w/ Silver & Fit (PPO)
• Blue Shield 65+ HMO Advantage Plan w/ Silver & Fit (HMO)
• Kaiser Permanente Senior Advantage $10 Plan w/ Silver & Fit (HMO)

ADDITIONAL RETIREE FORMS

If you need to change your address or you need to remove spouse/dependents please use the following forms. Please note, if you are removing a spouse/dependent outside of open enrollment you must provide proof of other coverage showing their name and the effective date and you must do so within 30 days of the effective date:

• Click here to access the SISC Membership Change Form (Certificated and Management/Confidential retirees)
• Click here to access the CVT Membership Change form (Classified retirees enrolled in medical insurance)
• Click here to access the Delta Dental Change Form (Classified retirees enrolled in dental)
• Click here to access the VSP Change Form (Classified retirees enrolled in vision insurance)

If you are enrolled in the 55-64 Kaiser retiree plan and you are turning 65 please fill out and turn in the following form along with a copy of your Medicare card showing enrollment in both parts A & B at least 45 days prior to the 1st of the month of your 65th birthday if you will remain enrolled in the Kaiser plan.

• Kaiser Senior Advantage Form (Certificated & MGMT/CONF retirees) 

2020/2021 Retiree Open Enrollment Selection Forms (will be available in July 2020)

• Certificated Retiree Open Enrollment Selection Form
• Management/Confidential Retiree Open Enrollment Selection Form
• Classified Retiree Open Enrollment Selection Form