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Benefits Enrollment Forms & Resources

General Forms and Resources


  • 2020-2021 Benefits Guide
  • 2020-2021 Benefits Guide (PDF version)
  • 2021-2022 Benefits Guide
  • 2021-2022 Benefits Guide (PDF version)
  • Affordable Care Act – Health Care FAQ
  • Uniform Glossary for Summary of Benefits and Coverage (© 2013 DOL.gov)

If you're having trouble accessing any of the above please please contact us for accommodations. 


Benefits - Standard Plans


  • For Benefit Summaries please visit Benxcel
  • MidAmerica Beneficiary Designation Form (© 2009 MidAmerica)
  • MidAmerica Disbursement Request Form (© 2009 MidAmerica)

Benefits - Voluntary Plans


  • AFLAC Product Overview & Contact
  • WEX Benefits Open Enrollment Toolkit 
  • WEX Benefits List of Eligible Expenses

Note: If you are unable to access these documents and require additional accommodations, please contact czamora5@pasadena.edu.

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Contact Us
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07/04/2022

  • Pasadena City College
  • 1570 E. Colorado Blvd.
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    626 585 7123
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