Enrollment

Enrollment in the Peralta Colleges Benefits Plan is mandatory for employees (and their eligible dependents) who wish to participate in the welfare benefits program. Please fill out the form provided and return it to the benefits department for processing. Please retain a copy of the enrollment form for your reference. This will serve as verification of enrollment while you wait for your identification cards from the applicable carriers.

If you would like to opt out of the Medical and Dental Insurance plans and recieve cash lieu of enrollment, please download, fill out, and return the Cash in Lieu Form provided below.

2011 Open Enrollment

2011 Benefits Open Enrollment!!!
The Peralta Community College District will hold its annual open enrollment for all benefit-eligible active and retired employees and surviving spouses from:

October 1 – October 31, 2011

Please download and print the following document in PDF format
which provide details and required forms for enrollment/re-enrollment in the benefit plans.
Note: Deadline for enrollment is October 31, 2011

2011 Open Enrollment Announcement
2011 Open Enrollment Benefits Fair Schedule Postcard (Front)
2011 Open Enrollment Benefits Fair Schedule Postcard (Back)
CIGNA Voluntary Life Enrollment Oct 6, 2011
Flexible Spending Accounts Open Enrollment Packet

Enrollment Forms

Universal Enrollment Form

DOWNLOAD

This is the Peralta Colleges Benefits Plan Universal Enrollment Form. (Updated 7-14-2011)

File size: 139 K

Cash in Lieu of Insurance Form

DOWNLOAD

This is the Cash in Lieu of Insurance Form to be filled out in the event that you wish to opt out of the Peralta Medical and Dental Insurance plans and recieve cash in lieu of enrollment.

File size: 24 K

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Copyright (c) 2012 Peralta Benefits Information Center

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