New or Recently Updated

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 Enrollment Form

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

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

DistrictWell Program Activity Options

Participate in the Districtwell Well-Being Program! Winners will have the opportunity to earn a one-time payroll incentive!

OPEN ENROLLMENT! 2025 Benefits-at-a-Glance Booklet

This is the Benefits-at-a-Glance booklet for Open Enrollment 2025!

2024 HRA Screening Surcharge Program Details

See attached for the 2024 HRA Program Details! The deadline is November 15, 2024.

Hospital Indemnity Form – Preferred Benefit Administrators

Use this form for your Hospital Indemnity Reimbursement.

PBA Vision Reimbursement Form

Use this form for your PBA Vision Reimbursements.

Marathon Health Portal Guide_HRA Screening Program

See the guide provided by Marathon Health for navigating to the HRA Screening Program via the website or app!