Medical Forms
SISC Membership Change Form
File Size: 133 kb
File Type: pdf
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10 Month Employee Plans
File Size: 206 kb
File Type: pdf
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11 Month Employee Plans
File Size: 206 kb
File Type: pdf
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12 Month Employee Plans
File Size: 207 kb
File Type: pdf
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How to Find a PPO/In Network Anthem Provider
File Size: 139 kb
File Type: pdf
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Anthem Member Claim Form (for reimbursement)
File Size: 41 kb
File Type: pdf
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Plan G1 & G2 Summary of Benefits 2018/19
File Size: 142 kb
File Type: pdf
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Plan G1 & G2 Medical Benefit Booklet 2018/19
File Size: 1799 kb
File Type: pdf
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Plan K Summary of Benefits 2018/19
File Size: 143 kb
File Type: pdf
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Plan K Medical Benefit Booklet 2018/19
File Size: 1806 kb
File Type: pdf
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Plan M Summary of Benefits 2018/19
File Size: 141 kb
File Type: pdf
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Plan M Medical Booklet 2018/19
File Size: 1810 kb
File Type: pdf
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Health Plan Change Form 2018/2019
File Size: 607 kb
File Type: pdf
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MD Live Medical + Behavioral Health - Telemedicine Visits for $5
File Size: 733 kb
File Type: pdf
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Advanced Medical: Expert Medical Opinion
File Size: 581 kb
File Type: pdf
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Health Plan Comparison Grid 2018/2019
File Size: 605 kb
File Type: pdf
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SISC FLEX PLAN
File Size: 177 kb
File Type: pdf
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AIR MEDCARE FORM
File Size: 17107 kb
File Type: pdf
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Prescription Forms

Dental Forms
Navitus Prescription Drug Claim Form
File Size: 40 kb
File Type: pdf
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Navitus Pharmacy Booklet
File Size: 413 kb
File Type: pdf
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Navitus Contact Sheet
File Size: 77 kb
File Type: pdf
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Costco Rx Mail Order Brochure
File Size: 334 kb
File Type: pdf
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Costco Rx Mail Order Registration
File Size: 169 kb
File Type: pdf
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Evidence of Pharmacy Benefit
File Size: 444 kb
File Type: pdf
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Delta Dental Claim for Reimbursement
File Size: 375 kb
File Type: pdf
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Delta Dental Summary of Benefits & Coverage (effective October 1, 2015)
File Size: 515 kb
File Type: pdf
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Vision Forms






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Employee Assistance Program (EAP) 
Summary of MES Vision Benefits
File Size: 48 kb
File Type: pdf
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Vision Claim Form (English)
File Size: 64 kb
File Type: pdf
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Vision Claim Form (Spanish)
File Size: 34 kb
File Type: pdf
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Employee Assistance Program Flyer
File Size: 806 kb
File Type: pdf
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Basic Life Insurance
$20,000 policy included in a SISC Subscriber's health insurance premium
Life Insurance Beneficiary Change Form
File Size: 56 kb
File Type: pdf
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Basic Life Insurance
File Size: 95 kb
File Type: pdf
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Life Insurance Claim Form
File Size: 298 kb
File Type: pdf
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Life Insurance Conversion Application
File Size: 375 kb
File Type: pdf
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Summary of Basic Life Insurance Coverage - Classified
File Size: 27 kb
File Type: pdf
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Summary of Basic Life Insurance Coverage - Certificated
File Size: 27 kb
File Type: pdf
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Summary of Basic Life Insurance Coverage - Confidential/Management
File Size: 27 kb
File Type: pdf
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Voluntary Life Insurance
Additional coverage eligible employees elect with a voluntary payroll deduction
Life Insurance Beneficiary Change Form
File Size: 56 kb
File Type: pdf
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Life Insurance - Portability (to take the policy with you when you leave the District)
File Size: 102 kb
File Type: pdf
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Voluntary Term Life Insurance - Enrollment Form
File Size: 123 kb
File Type: pdf
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Voluntary Life Insurance - Evidence of Insurability
File Size: 250 kb
File Type: pdf
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Domestic Partner Dependents
Affidavit to Add a Domestic Partner
File Size: 33 kb
File Type: pdf
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Domestic Partner Enrollment Guidelines (AB 205 and non-AB 205)
File Size: 90 kb
File Type: pdf
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Preventative Care Totally Covered by Anthem
File Size: 243 kb
File Type: pdf
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Wellness 
Ukiah Area Health Club & Fitness Center Discounts
File Size: 71 kb
File Type: pdf
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Ukiah Area Wellness Resources
File Size: 589 kb
File Type: pdf
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Solera 4 Me: Diabetes Prevention Program
File Size: 595 kb
File Type: pdf
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Ukiah Area Addiction Resources
File Size: 90 kb
File Type: pdf
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