Categories
2024 – 2025 Family Status Change Forms
If you have a family status change, or qualifying event, use the forms to complete the enrollment.
2024 – 2025 Active Enrollment Form
The Active Enrollment Form is used for any changes for employee enrollment.
2025 Retiree Spousal Affidavit
If you cover a spouse on the SJCSD Medical Plans, please be sure to fill out the attached form.
2025 Retiree Benefits-at-a-Glance Booklet
SJCSD 2025 Retiree Benefits can be found in this booklet.
Wellness Program Notice
See attached for the Wellness Program Notice
St. Johns County School District Self-Funded Health Plan Notice of Privacy Practices
SJCSD Notice of Privacy Practices
CHIP Model Notice
Children's Health Insurance Program Information
2025 Retiree Enrollment Form
Use this form to make changes to your retiree benefits for 2025.
2024 – 2025 Active Enrollment Form
The Active Enrollment Form is used for any changes for employee enrollment.
2024 – 2025 Family Status Change Forms
If you have a family status change, or qualifying event, use the forms to complete the enrollment.
Florida Blue Gym Discounts & More!
Check out fitness discounts, nutrition programs and more through Blue365!
Preferred Benefits Administrators – Setting Up Your Account
This flyer will assist you with setting up your account with PBA online.