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Benefits Forms and Documents
Human Resources

Below you will find links that will take you to various Benefits forms and documents.

Benefits Documents
New Content
Document Title
File(s)
Notes
  Benefits Contact Information PDF  
  CCA Retiree Options and Benefits FAQ PDF  
  Open Enrollment Announcement PDF 2011-2012
  Q&A Regarding Health and Welfare Benefits Upon Layoff PDF  
Benefits Highlights
  Academic Employees Benefits Highlights PDF 2011-2012
  Classified and Management Employees Benefits Highlights PDF 2011-2012
Anthem Blue Cross HMO
  Blue Cross HMO Plan Summary - All PDF  
  Blue Cross HMO Rx A Plan Summary - All PDF  
  Express Scripts Mail Order Rx Form PDF  
  How to Use Mail Order Rx PDF  
  Preventive Health Care Services PDF  
Anthem Blue Cross PPO
  Blue Cross PPO Plan Summary - Academic PDF  
  Blue Cross PPO Plan Summary - Classified & Management PDF  
  Blue Cross PPO Rx Plan Summary - All PDF  
  Express Scripts Mail Order Rx Form PDF  
  How to Use Mail Order Rx PDF  
  Preventive Health Care Services PDF  
Kaiser Permanente
  Kaiser HMO Plan Summary - All PDF  
  Preventive Services Coverage PDF  
Delta Dental HMO
  Delta Dental HMO DeltaCare EOC - All PDF  
Delta Dental PPO
  Delta Dental PPO Plan Summary - All PDF  
Managed Health Network (MHN)
  MHN Employee Assistance Program- All PDF  
  MHN EOC- All PDF  
Vision Service Plan (VSP)
  VSP Summary-All PDF  
  VSP Out-of-Network Claim Form PDF  
Employee Benefit Contributions
  CCA Benefits Contributions PDF 2011-2012
  AFT and Management Plan Coverage Contributions PDF 2011-2012
Other Benefits Documents
  Classified Employee Election of Retiree Medical Benefits Link Form HR034; external link to LBCC Forms Storage
  Futuris Trust Summary Annual Report PDF September 2009
  Futuris Benefit Trust PDF 7/1/08 - 6/30/09
  Insurance Continuation Rights PDF COBRA Notification.
  Life Insurance Announcement PDF Effective 10/01/05
  Summary of H&W Premium Costs PDF 2011
  Employee Benefits Plan Compliance & Annual Disclosure Notices PDF 2010
  PARS Financial Report PDF June 2009

 

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