Pasadena City College, Home of the PCC Lancers

Human Resources Benefits Forms

Benefits - General

* 2013-14 PCC Benefits Enrollment Guide (© 2013 Keenan)

* Affordable Care Act - Health Care FAQ

* New Health Insurance Marketplace Coverage Options and Your Health Coverage (© 2013 DOL)

* Uniform Glossary for Summary of Benefits and Coverage (© 2013 DOL.gov)

 

Benefits - Standard Plans

* Anthem/Blue Cross Enrollment Form ( © 2009 AnthemBlue Cross)

* Delta Dental Enrollment Form (© 2005 Delta Dental)

* Delta Dental Insurance Claim Form (© 2010 Denta Dental)

* Kaiser Enrollment Form (© 2010 Kaiser)

* Kaiser Permanente Emergency Claim Form (© 2010 Kaiser Permanente)

* Kaiser Senior Advantage Enrollment Form (© 2010 Kaiser Permanente)

* MES Claim Form (© 2010 MES-Medical Eye Service)

* MES Enrollment and Change Form (© 2010 MES-Medical Eye Service)

* MES Summary Plan Description - Eyeware only (© 2010 MES-Medical Eye Service)

* MES Summary Plan Description - Full plan (© 2011 MES-Medical Eye Service)

* MidAmerica Beneficiary Designation Form (©2009 MIdAmerica)

* MidAmerica Disbursement Request Form (© 2009 MidAmerica)

* The Standard Insurance - Beneficiary Change Form (© 2009)

* The Standard Insurance - Enrollment Form (© The Standard Insurance)

 

Benefits - Voluntary Plans

* TakeCare WageWorks dependant Care FSA Brochure (© 2014 TakeCare WageWorks)

* TakeCare WageWorks Depend Savings Form Claim (© 2014 TakeCare WageWorks)

* TakeCare WageWorks Enrollment Form (© 2014 TakeCare WageWorks)

* TakeCare WageWorks Health Savings Form Claim ( © 2014 TakeCare WageWorks)

* TakeCare WageWorks HealthCare FSA Brochure ( © 2014 TakeCare WageWorks)

* The Standard Insurance - Additional Life coverage ( © 2011 The Standard Insurance)