Health Benefit Forms
- Active Employees
- Open Enrollment for existing benefit eligible Active employees was a virtual process through MyCUSD 10/16 - 11/01. Paper changes are not accepted.
- If you are trying to submit documents to make changes to your coverage outside of your new hire/ newly benefit eligible timeline or Open Enrollment, please reference the tab on our homepage labeled, 'Qualifying Life Events', for more information.
- Enrollment and Changes Form
- Can be submitted for new hires, newly eligible employees, qualifying events, or Retiree Open Enrollment changes.
- Acceptable Supplemental Dependent Documents Guideline
- If you added dependents during Open Enrollment, we need copies of all documents by no later than Monday, December 14, 2026.
- SS # Form (ex. Used for newborns if an enrollment/ changes form was already submitted and SS # was received later on)
- If you are adding dependents to your coverage, we can accept copies of documents. Per board policy (1340), if you bring in an original document without a copy, we can make a copy for $0.25 per page (cash only).
- Please send completed documents containing sensitive information to our department via fax, district mail, US mail, or in person (not via email).