Categories
Forms
Flexible Spending Account Enrollment Form
Use this form when enrolling in Flexible Spending Accounts.
Fillable Vision Claim Reimbursement Form
Don't have access to a printer? Use this form to submit your vision claim reimbursements.
2019-2020 SJCSD Insurance Rates
Updated rates increased 11/15/2019
Mutual of Omaha Conversion Application
Use this form to convert your Mutual of Omaha Life Insurance policy.
Mutual of Omaha Portability Application
If you plan to port your Mutual of Omaha Life Insurance, use this form.
2020 Vision Claim Reimbursement Form
Use this form for vision claim reimbursements in 2020.
Retiree 2020 Plan Year Enrollment Form
This form is for retirees making enrollment changes in 2020.
Active Enrollment Form 2019-2020 – New Rates
Be sure to use this form for any 2019-2020 active enrollment changes.
2020 – 2021 Working Spouse Affidavit
This form is used when you are adding a spouse to the medical plans.