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Employees must elect medical coverage; dependent coverage is optional. 

Eligible dependents are:

  • Legally married spouse
  • Registered domestic partner
  • Children to age 26 including stepchildren, children of a registered domestic partner, legally adopted children, a child for whom a Qualified Medical Child Support Order (QMCSO) that complies with all applicable laws has been issued, children or grandchildren for whom the member has been awarded court appointed guardianship (to age 18)
  • Disabled children (Social Security determinationrequired/no age maximum)

If you choose to decline enrollment for your dependent(s) because of other health insurance coverage, you may in the future be able to enroll your dependent(s) in a health plan, provided that you request enrollment within 31 days after your other coverage ends.  In addition, if you have a new dependent as a result of a qualifying event, such as marriage, Declaration of Domestic Partnership, birth, adoption, or placement for adoption, you may be able to enroll your dependent, provided you request enrollment within 31 days following the date of the qualifying event.

Health Plan Options

Kaiser HMO Plan

Group ID: 234480-0119 (Effective March 1, 2024)
Kaiser Membership Services: (800) 464-4000
List of locations and other benefits: www.kp.org

$10 Office Visit co-pay
$10 Prescription co-pay

* Chiropractic services provided by: American Specialty Health (ASH). ASH Provider Directory or (800) 678-9133

SISC Anthem Blue Cross (PPO) Effective March 1, 2024.

Group ID: 40972
Questions about eligibility, benefits or if you need help finding an in-network provider:

Member Services: https://www.anthem.com/ca/sisc/ 800.825.5541

The SISC Anthem Blue Cross (PPO) plan offers two levels of coverage based on doctor of choice:
In-network Provider:
Plan Pays 80%, Employee Pays 20% after deductible
$20 Office visit co-pay ($0 copay for visits 1-3, then $20 copay for visits 4+.)
Annual Deductible: $300 Individual / $600 combined
Annual Out-of-Pocket Maximum: $1,000 per individual OR $3,000 per family (excludes prescription co-pays)

Out-of-Network Provider Coverage:
Annual Deductible: $300 Individual / $600 Family + charges over allowed amount
Annual Out-of-Pocket Maximum: No Limit

Prescriptions (30 or 90 day supply): 
Out of Pocket Maximum: $1,500 Individual/$2,500 Family
Prescription co-pay (generic meds): $7 (30 day) through Navitus/No Charge through Costco (30 or 90 day)
Prescription co-pay (Brand Name Drugs meds): $25 (30 day) through Navitus/$25/$60 through Costco (30/90 day)
Prescription co-pay (Specialty meds): $25 (30 day mail) through Navitus
Mail Order Prescriptions: Navitus or Costco
Navitus phone number: 8663332757
Website: Navitus.com

SISC Anthem PPO Plan Summary
SISC Antehm PPO Detailed Explanation of Coverage
SISC Anthem PPO Provider Network: https://www.anthem.com/ca/sisc/find-care/, Select “PPO” then “Search for a PPO Network Provider”, If you have a provider in mind, type in the doctor’s name and search, To find a new provider, enter you zip code and select the type of care.
SISC Anthem PPO Evidence of Coverage
HIPAA Privacy Notices

This summary of benefits is informational only and is not a complete description of all applicable conditions. Coverage and plan offerings are subject to change in subsequent years pursuant to District policy.