Use this form to make changes to your retiree benefits for 2025.

The Active Enrollment Form is used for any changes for employee enrollment.

If you have a family status change, or qualifying event, use the forms to complete the enrollment.

Use this form for your PBA Vision Reimbursements.

If you cover a spouse on the SJCSD Medical Plans, please be sure to fill out the attached form.

Use this form for your Hospital Indemnity Reimbursement.

Need to file a vision claim? Use this form to file directly with Preferred Benefit Administrators (PBA).

If you want to enroll in Voya Additional Term Life Insurance, use this form.

Use this form when enrolling in Flexible Spending Accounts.