INSURANCE BOOKLET - CLASSIFIED ACTIVE
20-21 PLAN RATES
Medical Plan Descriptions
KAISER $20
KAISER DHMO
ANTHEM PREMIER HMO
Premier HMO Prescription Coverage
ANTHEM CLASSIC HMO
Classic HMO Prescription Coverage
ANTHEM CLASSIC PPO $20
Premier PPO Prescription Coverage
ANTHEM CLASSIC PPO $40
Classic PPO Prescription Coverage
Medical Plan Explanation of Benefits (EOC)
Kaiser $20 FULL Explanation of Coverage (EOC)
Kaiser DHMO FULL Explanation of Coverage (EOC)
Anthem Premier HMO FULL Explanation of Coverage (EOC)
Anthem Classic HMO FULL Explanation of Coverage (EOC)
Anthem PPO 20 FULL Explanation of Coverage (EOC)
Anthem PPO 40 FULL Explanation of Coverage (EOC)
MEDICAL FORMS (Please print form and complete)
MEDICAL PLAN ELECTION FORM
ANTHEM BLUE CROSS ENROLLMENT FORM
CHANGE FORM
KAISER ENROLLMENT/CHANGE FORM
WAIVER FORM
Anthem Blue Cross Anthem Blue Cross
HMO Provider Finder PPO Provider Finder
American Specialty Health (ASH) Chiropractic
All Medical Plan Members: 800-678-9133
Prescription Drug Program for non-Kaiser Members
NAVITUS CUSTOMER CARE
HOURS: 24 Hours a Day | 7 Days a Week
866-333-2757 (toll-free) TTY (toll-free) 711
MAILING ADDRESS: Navitus Health Solutions P.O. Box 999 | Appleton, WI 54912-0999
Anthem Blue Cross members have access to a MDLIve appointment for a $5 co-pay.
Please check the link here for more information: MDLive Appointment Information
Additional Medical Plan Forms and Information
IMPORTANT: If enrolling dependents, you must provide proof of dependent relationship. Please see dependent verification requirements: Dependent Verification Documents
Anthem Temp Medical ID Card
COSTCO Prescription Drug Flyer - Not valid for Kaiser members
ADVANCE MEDICAL - Expert Medical Opinion
It's free, it's easy, it's 100% confidential. 855.201.9925 | advance-medical.net/sisc
Advance Medical is fully sponsored by Self-Insured Schools of California.
All of Advance Medical's services including Expert Medical Opinion are available at no cost to all members covered by a SISC health plan. Advance Medical Information Flyer
For all SISC Anthem Members:
SOLERA - It's a 16-week, cutting-edge program that can help you lose weight, adopt healthy habits and significantly reduce your risk of developing diabetes. And it's available at no cost to members that qualify.
877.486.0141 | solera4me.com
For all SISC PPO Members:
Need surgery for Hip Replacement, Knee Replacement or Spinal Fusion? Contact Carrum Health at 888-855-7806
Get Access to top quality surgeons at Scripps Medical, No medical bills (co-insurance and deductibles are waives), and travel expenses are covered.