• Acceptable Supplemental Dependent Documents
• Medical Side-by-Side Comparison Sheet
• Health Benefit Rates (Monthly Premiums)
• How to Find a UHC HMO PCP
• How to Find a UMR Select Plus PPO PCP
• How to Find a Cigna PCP
  • If a provider number has less than ten digits, you will need to add zeros before. 
• Express Scripts (Applicable to UHC/ UMR Only)
• Kaiser Permanente
• Delta Dental Plans
• VSP Vision Plan
• Enrollment and Changes Form
• District Sponsored Group Life Insurance (Employer Paid)
  
  • New York Life Insurance Beneficiary Form
  • $30,000 District Sponsored Coverage for CSEA, TEAMSTERS, and CUEA Employees
  • $50,000 District Sponsored Coverage for CUMA Employees
• Supplemental Life Insurance Form (Employee Paid)
  •  New York Life Supplemental Application Form 
    
    • Non-medical maximum amounts are automatically approved within the first thirty days of initial health benefit eligibility.
    • If you are applying for over the guaranteed amount (Employee: Over $200,000, Spouse: Over $50,000), you will need to complete the Evidence of Insurability Form. 

What do I need to turn in to enroll in health benefits?

• Personalized Receipt Acknowledgement Form (provided directly to newly health benefit eligible employees by our department)
• Enrollment and Changes Form
• Copies of Supplemental Dependent Documents (if you are adding dependents to your coverage)
  • We do not need to see original documents. Per board policy (1340), if you bring an original document without a copy, we can make a copy for $0.25 per page (cash only). 
• NY Life Beneficiary Form (District Sponsored Life Insurance Policy)
  
  

I don't need to enroll in health benefits through the district, what do I need to turn in to decline coverage?

• Personalized Receipt Acknowledgment Form (provided directly to newly health benefit eligible employees by our department)
• NY Life Beneficiary Form (District Sponsored Life Insurance Policy)

How do I turn in my completed documents?

• Documents that contain SS #'s cannot be sent via email. 
• All documents can be submitted via fax (949-487-0671), district mail, US mail (CUSD ATTN: Insurance Department 33122 Valle Road, San Juan Capistrano, CA 92675), or in person.
  • Our department is open Monday - Friday, 8am - 4:30pm. 
• Have more questions? Contact someone in our department!
  
  

Mandatory Disclosures

• New Health Insurance Marketplace Coverage
• American Fidelity - Additional External Coverage Options
• Facts About Workers' Compensation - Athens 
• Facts About Workers' Compensation in Spanish - Athens
• Medical Provider Network - Athens
• Medical Provider Network in Spanish - Athens