New Enrollment Packet
- 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)
- UNUM Group Life Insurance Beneficiary Form (through 04/30/2026)
- NY Group Life Insurance Beneficiary Form (effective 05/01/2026)
- $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)
- UNUM Application Forms (through 04/30/2026)
- CSEA, TEAM, CUEA UNUM Supplemental Life Insurance Brochure and Application Form
- CUMA UNUM Supplemental Life Insurance Brochure and Application Form
- New York Life Application Form (effective 05/01/2026)
- 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, you will need to complete the Evidence of Insurability Form.
- UNUM Application Forms (through 04/30/2026)
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).
- UNUM Group Life Beneficiary Form
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)
- UNUM Group Life Beneficiary Form
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!
