Welcome to Employee Benefits

Empire Union School District provides a comprehensive benefits package for employees who meet the minimum requirements for coverage including...

Medical, Dental, Vision, Disability and Basic Life Insurance Plans Participation in CalSTRS or CalPERS retirement systems Employee Assistance Programs Optional supplemental Life & AD&D insurance plan Optional participation in 403(b) & 457(b) Tax-Sheltered Investments Optional participation in critical illness & other supplemental insurances Optional participation in Flexible Spending Account programs

Questions regarding Benefits? Contact: C.W. Smith - Human Resources (209) 521-2800 x2219 CSmith@empire.k12.ca.us

Certificated Employees

Certificated Employees (CVT)

Benefits

Open Enrollment is August 1, 2022 through August 26, 2022

Certificated Employees are eligible to make changes to and/or enroll in the following benefits:

  • CVT Health Plan

  • Delta & United Healthcare Dental Plans

  • Vision Service Plan (VSP)

No plan cost changes for Dental & Vision

See sections below for Plan Documents, Rates & Enrollment Forms 

Plan Cost Adjustment effective September 2022 Payroll

Coverage Changes Effective October 1, 2022

Required documents when enrolling in any available health benefit:

Spouse

  • Marriage Certificate 

  • Child(ren)

    Birth Certificate(s)

All documents are due to Shaundra Lopez at the District Office no later than Friday, August 26, 2022.

Affordable Care Act
Contact Shaundra Lopez at (209) 521-2800 x 2219 or shlopez@empire.k12.ca.us

COBRA Rights
General Notice of COBRA Rights

CVT HIPPA
CVT Notice of Privacy Practices

DID YOU KNOW: 

  • MyCVT can be your one-stop-shop resource for your health benefit needs!

  • If you are not registered with MyCVT you can do so by going to https://mycvt.cvtrust.org/  ... Click Here for Instructions

  • That you can connect directly to CVT benefit partners from MyCVT without having to sign into multiple sites? Even print replacement cards!

  • MyCVT also connects you to special programs?  Need counseling, legal or financial advice? Employee Assistance Program EAP could help.  Bad cold getting worse and Dr. offices are closed? MDLIVE 24/7/365 Anytime, Anywhere!

  • You can update your Name/Address/Phone # - Documentation may be required.

  • You can Enroll/Dis-enroll dependents and/or change plans as a Qualifying Event or during Open Enrollment - Documentation maybe required.

Health Plans, Forms & Rates (CVT)
Contact Shaundra Lopez at (209) 521-2800 x 2219 or shlopez@empire.k12.ca.us

Forms
CVT Enrollment Form

Rates
Contact Shaundra Lopez at (209) 521-2800 x 2219 or shlopez@empire.k12.ca.us

Dental Plans & Forms

Dental Plan Summaries
Contact Shaundra Lopez at (209) 521-2800 x 2219 or shlopez@empire.k12.ca.us
Delta Dental Summary
United Healthcare Dental Summary

Forms
Delta Dental Enrollment Form
United Healthcare Dental Enrollment Form

Vison Plan & Forms
Contact Shaundra Lopez at (209) 521-2800 x 2219 or shlopez@empire.k12.ca.us

Forms
VSP Enrollment Form

CVT Anthem Blue Cross PPO 

Benefit Booklets
For a more in-depth look at Anthem Blue Cross PPO plans follow the links below. 
Contact Shaundra Lopez at (209) 521-2800 x 2219 or shlopez@empire.k12.ca.us

CVT Kaiser HMO Benefit Booklets
For a more in-depth look at Kaiser HMO plans follow the links below. 

Contact Shaundra Lopez at (209) 521-2800 x 2219 or shlopez@empire.k12.ca.us

CEC Classified, Classified Confidential, Board & Management Employees (SISC)

Open

Open Enrollment is August 1, 2022 through August 26, 2022

CEC Classified, Confidential, Board & Management Employees are eligible to make changes to and/or enroll in the following benefits:

  • SISC health Plan

  • Delta & United Healthcare Dental Plans (No Plan Cost Change)

  • Vision Service Plan (VSP) (no plan cost change)  

See sections below for Plan Updates, Documents, Rates & Enrollment Forms 

Plan Cost Adjustment effective September 2022 Payroll

Coverage Changes Effective October 1, 2022

Required documents when enrolling in any available health benefit:

Spouse

  • Marriage Certificate

  • 1st Page of 2019 Federal Tax Return

    showing married filing status

  • Child(ren)

    Birth Certificate(s)

All documents are due to Shaundra Lopez at the District Office no later than Friday, August 26, 2022.

Affordable Care Act
ACA Notice - Benefits Eligible
ACA Notice - Benefits Ineligible

COBRA Rights
General Notice of COBRA Rights

SISC HIPAA
SISC HIPAA  Notice of Privacy Practices

CEC Classified Health Plans & Forms (SISC)

Health Plan Comparison Summaries

Forms
SISC PPO Enrollment Form
SISC Kaiser Enrollment Form
SISC WABE Election Form

Dental Forms
Delta Dental Enrollment Form
United Healthcare Dental Enrollment Form

Vison Plan & Forms
VSP Enrollment Form

CEC Classified Rates
Contact Shaundra Lopez at (209) 521-2800 x 2219 or shlopez@empire.k12.ca.us

CEC Classified Confidential, Board & Management Rates
Contact Shaundra Lopez at (209) 521-2800 x 2219 or shlopez@empire.k12.ca.us

Paraprofessional Rates
Contact Shaundra Lopez at (209) 521-2800 x 2219 or shlopez@empire.k12.ca.us

SISC Plan Summary of Benefits & Coverage (SBC)
Contact Shaundra Lopez at (209) 521-2800 x 2219 or shlopez@empire.k12.ca.us

Blue Shield Enrollment Guide 
Kaiser Enrollment Guide
Find a Provider Blue Shield PPO

SISC Plan Summaries 
Contact Shaundra Lopez at (209) 521-2800 x 2219 or shlopez@empire.k12.ca.us

CSEA Classified Employees (CalPERS)

Enrollment

Open Enrollment for CalPERS health Benefits is September 19, 2022 - October 14, 2022

CSEA Employees are now eligible to make changes to:

  • CalPERS Health Plans

See sections below for Plan Documents, Rates & Enrollment Forms 

Plan Cost Adjustment for CalPERS Health Plans effective December 2022 Payroll

CalPERS Health Plan Changes Effective January 1, 2023

Required documents when enrolling in any available health benefit:

Spouse

  • Marriage Certificate & Child(ren)

  • Birth Certificate(s)

All required CalPERS health documents are due to Shaundra Lopez at the District Office no later than Friday, October 14, 2022.

COBRA Rights
General Notice of COBRA Rights

CalPERS HIPPA
CalPERS Notice of Privacy Practices

CSEA Classified Health Plans & Rates (CalPERS)

Health Plans Comparison Summaries
Contact Shaundra Lopez at (209) 521-2800 x 2219 or shlopez@empire.k12.ca.us

Forms
CalPERs Health Enrollment Form

Rates
Contact Shaundra Lopez at (209) 521-2800 x 2219 or shlopez@empire.k12.ca.us

Dental Plans & Forms

Dental Plan Summaries
Contact Shaundra Lopez at (209) 521-2800 x 2219 or shlopez@empire.k12.c
Delta Dental Summary
United Healthcare Dental Summary

Forms
Delta Dental Enrollment Form
United Healthcare Dental Enrollment Form

Delta Dental
(866) 499-3001
www.deltadentalins.com

United Healthcare Dental
(877) 816-3596
www.myuhc.com 

Vison Plan & Forms


Vision Service Plan (VSP) Plan Summary
Contact Shaundra Lopez at (209) 521-2800 x 2219 or shlopez@empire.k12.ca.us

Forms
CVT Enrollment Form

Vision Service Plan
(800) 877-7195
www.vsp.com.

For a More Comprehensive Look at CalPERS Health Plan Coverage View Documents Below

CalPERS Health Plan Summaries of Benefits & Coverage (SBCs)

Information will be updated once 2023 information becomes available

  • Select HMO - Anthem Blue Cross 

  • Traditional HMO - Anthem Blue Cross

  • Access + HMO - Blue Shield 

  • Kaiser HMO 

  • PERS-Care PPO - Anthem Blue Cross

  • PERS-Choice PPO - Anthem Blue Cross

  • PERS-Select PPO - Anthem Blue Cross

CalPERS Health Plan Evidence of Coverage (EOCs)

Information is from 2021 and will be updated once 2022 materials become available

Contact Shaundra Lopez at (209) 521-2800 x 2219 or shlopez@empire.k12.ca.us

Anthem Blue Cross HMO
(855) 839-524
 www.anthem.com/ca/calpers

Blue Shield of California
(800)334-5847 
www.blueshieldca.com/calpers

Kaiser Permanente
(800) 464-4000 
www.kp.org/calpers

PERS Select/Choice/Care 
(877) 737-7776
www.anthem.com/ca/calpers