Retirees Benefits Information

These plans are for Retirees that are ages 65+.

Kaiser Plans

Kaiser Permanente Senior Advantage enrollment information for retirees over age 65 with Medicare Parts A & B 

• SISC KPSA Enrollment Instructions (2 pages, updated 9/25/2024)

• SISC Kaiser Enrollment Form (1 page)

• Kaiser Senior Advantage Election Form (6 pages)

• Dependent Eligibility Documentation Checklist (1 page)

• SISC Group Medicare Plan Comparison (1 page)

• KPSA $10 Benefit Summaries (2 pages)

• KPSA $25 Benefit Summaries (2 pages)

SISC (Medicare) NON-Kaiser Options 

• Instructions/Overview of Companion Care, Anthem PPO, and Blue Shield 65 Plus Medicare HMO (2 pages, updated 9/25/2024)

• SISC Group Medicare Retiree Plan Comparison (1 page)

• SISC PPO/EGWP and Companion Care Enrollment Form –  (16 pages) 

  • This is a combined form and the Medicare retiree selects a plan at the top of the Enrollment Form page, and Privacy Notice. 

  • SISC only needs pages 1-6 of the Enrollment Form returned

• Blue Shield 65 Plus Medicare HMO Advantage Plan (4 pages, update 9/24/2024)

• SISC Dependent Eligibility Documentation Checklist

Benefit Summaries Medicare Plans 

• Anthem Classic PPO Retiree Plan 100-A $0 

• Companion Care Medicare Supplement Plan

• Blue Shield 65 Plus (HMO)

• Kaiser Permanente Senior Advantage $10 (HMO) with Part D

• Kaiser Permanente Senior Advantage $25 (HMO) with Part D

Submit your forms:

All forms must be submitted to the Human Resources Office in-person or by mail. Please call 408-923-1855 to schedule an appointment or mail to:

Berryessa Union School District

ATTN: Sally Owyang

981 Ridder Park Drive

San José, CA 95131

Billing questions, please call 661-636-4410 and ask for "Direct Billing."