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Change Forms

SISC Membership Change Form (add or drop dependents, change of address, name, DOB, etc.) 
*Must have a qualifying event to add or drop dependents with proper documents. Please contact the Benefits Department regarding any questions.

Beneficiary Form -change life insurance beneficiary at any time.
Voluntary deduction Cancellation Form
* Please  note if you have deductions that are coming out pre-taxed you will have to wait until the end of the plan year to cancel it.


Claim Forms

Blue Shield of California
Claims mailing address:
P. O. Box 272540
Chico, CA   95927
(855) 256-9404

Anthem Select Blue Cross
Claims mailing address:

P. O. Box 60007
Los Angeles, CA 90060-0007
(800) 825-5541

Claims mailing address:
P.O. Box 261155
Plano TX 75026
(800) 392-8649

Claims mailing address:

P. O. Box 272540
Chico, CA   95927
(800) 642-6155

Delta Dental
Claims mailing address:

P. O. Box 997330
Sacramento CA. 95899-7330
(866) 499-3001

Claims mailing address:
3333 Quality Drive
Rancho Cordova, CA   95670
(800) 877-7195


Disabled Dependent Form
New Hire Paperwork

Benefits Enrollment Packet

21-22 RATES

22-23 RATES
*Certificated/ Management employees working a 50-90% FTE have to pay a percentage of the full premium amount equivalent to your percentage leave.
Opt Out Form 
*Only for employees that are working an FTE less than 90%


American Fidelity Assurance