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Benefit Information for all eligible employees

Blue Shield PPO (80-E)

Blue Shield PPO (80-J)

Blue Shield PPO (HDHP-B) High Deductible

Blue Shield HMO ($10-0)

Blue Shield HMO ($25-500)

Blue Shield HMO ($30-20%)

Kaiser HMO

Medical Plan Benefit Information for Non-Benefit Eligible Employees:

Contact Information

Blue Shield:

• Customer Service: (510) 607-2000

• Customer Service: (855) 256-9404

• Address: P.O. Box 272540 Chico, CA 95927-2540

Kaiser Permanente:

• Customer Service: (800) 464-4000

Contact Information:

• Customer Service: (888) 335-8227 M-F 8:00am-8:00pm Pacific Time

• Address: P.O. Box 997330 Sacramento, CA 95899-7330

• Website:

• Active Group Number: 7046-7505

• Retiree Group Number: 7046-7506

Forms:

Contact Information:

• Customer Service: (800) 877-7195

• Fax Number: (916) 851-4852

• Website:

• Email: imember@vsp.com

• Active Group Number: TBD

To add a spouse and/or dependent children, provide the following:

• Copy of marriage certificate

• Copy of current year Federal Tax 1040 Form (top sheet only)

• Copy of birth certificate(s) (Children Only)

Services:

Contact Information:

• Customer Service: (800) 999-7222

• Website:

• Company name: SISC

Life Insurance:

Disability Insurance:

Contact Information:

• Customer Service: (800) 289-9140

• Website:

• Maximum amounts that can be contributed for 2025:

• $3,200- Health Care Spending Account (increase from last year)

• $5,000- Dependent Care Spending Account

• $10 minimum per month for either account

Forms:

Contact Information:

• Dependent Care

• Unreimbursed Medical Program

• Customer Service: (425) 452-3500 or Toll-Free: (800) 669-3559

• Website:

• Mobile App Available

Submit a Claim:

• Email: claims@naviabenefits.com

• Fax: (425) 451-7002 or Toll Free: (866) 535-9227

• Address: P.O. Box 53250, Bellevue, WA 98015-3250

Medical Plans

Contact Information:

• Anthem Blue Cross Customer Service: (800) 825-5541

• Blue Shield Customer Service: (800) 642-6155

• Blue Shield Address: P.O. Box 272540 Chico, CA 95927-2540

• Blue Shield MDLIVE: (888) 632-2738

• Mental Health: (800) 256-9404

• SISC Dedicated Customer Service Unit: (855) 599-2657

• Kaiser Permante Customer Service: (800) 443-0815

Dental Plans

Rates effective October 1, 2024:

Dental Monthly Self-Pay Premiums:

• Single: $63.80

• 2-Person: $115.50

• Family: $166.10

• Retiree Dental Group Number: 7046-7506

Contact Information:

• Customer Service: (888) 335-8227

• Claims: P.O. Box 7736 San Francisco, CA 94120

Vision Plans

Rates effective October 1, 2024:

VSP Vision Monthly Self-Pay Premiums:

• Single: $8.80

• 2-Person: $17.60

• Family: $28.40

• Retiree Group Number: TBD

Contact Information:

• Customer Service: (800) 877-7195

• Fax Number: (916) 851-4852

• Website:

• Email: imember@vsp.com