Categories
Forms
Open Enrollment – 2026 Spousal Affidavit Form
Complete the Spousal Affidavit if you are covering a spouse on the medical plan.
Retiree Special Open Enrollment – 2025 Enrollment Form
Use this form for the Retiree Special Open Enrollment!
Added Benefit – Additional EAP Services through Voya!
As an added benefit for all employees through Voya, you can access their Employee Assistance Program (EAP) services at no additional cost to you!
2025 – 2026 Active Enrollment Form
The Active Enrollment Form is used for any changes for employee enrollment.
2025-2026 Family Status Change Form
If you have a family status change, or qualifying event, use the forms to complete the enrollment.
PBA Vision Reimbursement Form
Use this form for your PBA Vision Reimbursements.
2025 Retiree Spousal Affidavit
If you cover a spouse on the SJCSD Medical Plans, please be sure to fill out the attached form.
Hospital Indemnity Form – Preferred Benefit Administrators
Use this form for your Hospital Indemnity Reimbursement.
Voya Additional Term Life Insurance Enrollment Form
If you want to enroll in Voya Additional Term Life Insurance, use this form.