New or Recently Updated

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.

Retiree Special Open Enrollment – Spousal Affidavit

Use this form if you have a spouse on Retiree Medical for changes during the Retiree Special Open Enrollment.

Retiree Special Open Enrollment – Benefits-at-a-Glance Booklet

This is the Retiree Special Open Enrollment Booklet.

Retiree Special Open Enrollment – Memo for those who have Retiree Life Insurance ONLY

If you have only Life Insurance as a Retiree, this memo is for you.

Retiree Special Open Enrollment – Memo for those in Medical/Dental/Vision/Life

This memo is for Retirees with Medical, Dental, Vision, and Life.

Retiree Special Open Enrollment – 2025 Enrollment Form

Use this form for the Retiree Special Open Enrollment!

2025 HRA Screening Program Details

2025 HRA Screening Program Details

CHIP Model Notice

Children's Health Insurance Program Information

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!

SJCSD EAP Information – Dr. Townsend Clinic

This flyer has more information on the Employee Assistance Program for all SJCSD Employees and family members!

2025 Retiree Spousal Affidavit

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