Open Enrollment

May 2 through May 20, 2022

What Open Enrollment Means
During the open enrollment period (May 2nd through May 20th), you have an opportunity to to make changes or corrections to your insurance.

All current plan selections will be carried over to the 2022-2023 year*, unless you elect to make changes during open enrollment, such as:
- Enroll in a PPO or HMO medical plan for the first time
- Switch medical plan provider (Kaiser/Aetna or Kaiser/Blue Shield for teachers)
- Add or remove spouse or dependents
- Enroll in or cancel voluntary benefits
- Increase or decrease your voluntary life and AD&D supplemental insurance plans
- Enroll/Re-enroll in the American Fidelity Section 125 Flexible Spending Account (Medical FSA or Dependent Care FSA). *Exception: You must re-enroll in the Section 125 FSA each year to continue enrollment even if you are electing the same dollar amount. Contact American Fidelity directly at (800) 365-9180 press 0 or schedule an appointment with an American Fidelity Representative by clicking here.

How to Enroll and/or Make Changes during Open Enrollment
Download and print enrollment form(s) or enrollment change form(s) and submit completed forms to Personnel Services no later than 5:00 pm on 5/20/2022. Forms can be downloaded below.

Changes made during open enrollment go into effect July 1, 2022 except for Certificated (VETA Member) SISC Medical Plan Changes which go into effect October 1, 2022.

•  Join us for The VESD Way Employee Health and Wellness Expo
Thursday, 5/5/2022
3:00 pm to 6:00 pm
Hilton Garden Inn - Conference Center
12603 Mariposa Rd, Victorville, CA 92395
Click here to view event flyer
- Personnel Services will be available at the Expo to answer questions and provide forms for Open Enrollment changes
- Insurance providers will also be available to help answer questions about your benefits.

MEDICAL PLAN ENROLLMENT CHANGE FORMS for High Desert Trust (HDIEET) Medical Plans available to Psychologists, Classified, Management and Confidential employees and retirees. Click on forms below, print and submit completed originals to Personnel no later than Friday, May 20, 2022

Form to enroll in Aetna PPO w/ Bridge Plan

Form to enroll in Aetna HMO w/ Bridge Plan

Form to enroll in Kaiser HMO w/ Bridge Plan
(attach separate sheet if more space is needed to list all dependents)

CERTIFICATED MEDICAL PLAN ENROLLMENT CHANGE FORMS for SISC Insurance Trust Medical Plans available to Certificated (VETA Bargaining Unit Members) employees and retirees - Teachers, Speech Therapists and Nurses. Click on forms below, print and submit originals to Personnel no later than Friday, May 20, 2022 (SISC plan changes go into effect 10/1/2022)

Form to enroll in SISC Blue Shield PPO

Form to enroll in SISC Blue Shield HMO

Form to enroll in SISC Kaiser HMO
(print extra copies of enrollment page if more space is needed to list all dependents)

ADDING OR DROPPING SPOUSE OR DEPENDENT(S)
Click on forms below, print and submit completed originals to Personnel no later than Friday, May 20, 2022

Psychologists, Classified, Management and Confidential employees and retirees use forms below to add or drop a spouse or dependent from your HDIEET medical plan.

Aetna PPO Enrollment Change Form

Aetna HMO Enrollment Change Form

Kaiser Enrollment Change Form

Certificated (VETA Bargaining Unit Members) Teachers, Speech Therapists and Nurses employees and retirees use form below to add or drop a spouse or dependent(s) from your SISC Medical Plan
SISC Membership Change Form

Dental, Vision and Voluntary Benefit Forms below can be used by all benefit eligible employee and retiree groups for Open Enrollment changes.

Delta Dental Enrollment Change Form

Vision Service Plan (VSP) Change Form

OPTIONAL VOLUNTARY INSURANCE PLANS
The following optional voluntary insurance plans have a cost associated with them which is taken as a payroll deduction.

Mutual of Omaha Supplemental Life Insurance Benefit Summary
Mutual of Omaha is the life insurance provider for your district-paid basic life insurance plan through the High Desert Trust (HDIEET). If you wish to purchase additional life insurance coverage through this provider, please contact Veronica Taylor in Personnel for eligibility requirements, coverage limits and enrollment form.

MetLaw Benefit Brochure
Cost to enroll is this affordable legal services plan is $22.02 monthly, taken as a payroll deduction on a tenthly basis (ten months out of the year). Click Here for MetLaw Enrollment Form. Print and submit completed form to Personnel no later than May 20, 2022.

Section 125 Flexible Spending Account
CLICK HERE to schedule an appointment with an American Fidelity Representative
or call American Fidelity directly at 1-800-365-9180, option 0, to receive information, enroll for the first time, or to continue enrollment in your Section 125 Flexible Spending Account. Employees enrolled in a Section 125 Flexible Spending Account must re-enroll every year to continue participating their Section 125 plan.

403(b) Voluntary Retirement Plan
Schools First is our district’s third party administrator for the 403(b) voluntary retirement plans. Contact Michael J. Duarte at 1-800-462-8328, ext 4116, option 1 or email at [email protected], for information or to enroll. Click following link for information available online at the SchoolsFirst Website

TO CANCEL VOLUNTARY INSURANCE PLANS

To cancel Mutual of Omaha Supplemental Life Insurance or MetLaw, submit a written a request to Personnel Services by May 20, 2022

To cancel Section 125 Flexible Spending Account or other American Fidelity voluntary plans you will need to contact American Fidelity directly at 1-800-365-9180, option 0.

To cancel 403(b) Retirement Plan contributions contact Schools First directly at 1-800-462-8328, ext 4116, option 1

PLAN BENEFIT SUMMARIES

2022-2023 Aetna PPO with Bridge Plan