Resources

Self-funded Medical Plan for Actives

• Anthem Blue Cross website
• UAS Portal for Anthem EOB access
• Find an Anthem Doctor
• Anthem Summary of Benefits (2024)
• Anthem PPO Enrollment Form
• Anthem Claim Form
• Anthem PPO Disclosure
• Maxor Prescriptions website
• Maxor Summary of Benefits
• Maxor Prescription Claim Form

Kaiser Medical Plan for Actives

• Kaiser website
• Kaiser Summary of Benefits (2024)
• Kaiser HMO Enrollment Form
• Kaiser Chiropractic Benefits

Medical Plans for Retirees (Age 65+)

Medicare-eligible retirees have the choice of the following plans:

• Alignment Medicare Advantage Summary of Benefits (2025)
• Alignment Medicare Advantage FAQs
• Kaiser Senior Advantage Summary of Benefits (2024)
• Kaiser Senior Advantage Enrollment Form
• Hartford Medicare Supplement Summary of Benefits (2019)
• Hartford Medicare Supplement Enrollment Form
• SSA Request for Employment Information L564 (for Medicare)

Forms

• Address Change Form
• Beneficiary Form
• Electronic Deposit (EFT for pension payments)

Part A Defined Benefit Forms

• Part A Pension Application Packet
• Part A Long-term Disability Application Packet
• Part A Health & Welfare Withholding Form

Part B Defined Contribution & 401K Forms

• Part B Pension Application Packet
• Part B Long-term Disability Application Packet
• Part B Change Investment Form
• Part B Distribution Form (Married)
• Part B Distribution Form (Single)
• Part B Pension Loan Application
• Part B Mandatory Payment of Small Account Balances Form

Tax Form Links

• Tax Withholding, Federal (IRS website)
• Tax Withholding, State (CA EDD website)
• Tax Withholding, State (Spanish) (CA EDD website)