Medical Program Information
Blue Shield Documents
Plan Comparisons
Comparación de Planes en Español
Blue Shield 80% PPO (xlsx Espanol)
Blue Shield 90% PPO (xlsx Espanol)
Blue Shield 100% PPO (xlsx Espanol)
Blue Shield $1700 HDHP (xlsx Espanol)
Blue Shield $3400 HDHP (xlsx Espanol)
Blue Shield 2-tier HSA $5000 (xlsx Espanol)
Blue Shield Forms
Blue Shield Enrollment Form (PDF)
Existing Member Change Form (.doc)
Medical, Dental & Vision Address Change Form (PDF)
SISCconnect Registration Form (PDF)
SISC Affidavit of Marriage (PDF)
Transfers - Maintenance Activity Report (PDF)
Termination of Subscribers - Maintenance Activity Report (PDF)
Blue Shield Declaration of Disability for Over Age Dependent Child (PDF)
Blue Shield HSA 2 Tier MEC 9000 (PDF)
Blue Shield HSA 2 Tier HSA 5000 (PDF)
Blue Shield Mental Health
Blue Shield Benefit Summaries
These matrixes are intended to be used to help you compare coverage benefits and is a summary only. The plan contract should be consulted for a detailed description of coverage benefits and limitations.
October 2024 to September 2025
2024-2025 RX Plans & Information (PDF)
80% PPO Plan G Benefit Summary (PDF)
90% PPO Plan E (Frozen) Benefit Summary (PDF)
100% PPO Plan B Benefit Summary (PDF)
HSA - Plan A Individual - Benefit Summary (PDF)
HSA - Plan A Family - Benefit Summary (PDF)
HSA - Plan B - Benefit Summary (PDF)
2-Tier HSA (Formerly Anchor Bronze) Benefit Summary (PDF)
Resúmenes de Beneficios de Blue Shield en Español: Octubre 2024 a Septiembre 2025
Blue Shield & Navitus Prescription
Summary of Benefits & Coverage
The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan would share the cost for covered healthcare services. NOTE: Information about the cost of this plan (called the premium) will be provided separately. This is only a summary.
October 2024 to September 2025
100-B PPO - $20 Office Visits, $7 to $25 Prescriptions (PDF)
90-E PPO (Frozen) - $20 Office Visits, $7 to $25 Prescriptions (PDF)
80-G PPO - $30 Office Visits, $9 to $35 Prescriptions (PDF)
2-Tier HSA (Formerly Anchor Bronze) (PDF)
Waiver of Active Benefit Enrollment - WABE
SISC Benefit Handbook WABE Option (PDF)
WABE District Letter of Understanding (docx)
WABE Employee Election Form (docx)
Blue Shield Value-Added Services
Costco Zero Dollar Generics (PDF)
PPO Zero Dollar Copay First Three PCP Visits (PDF)
PPO & HMO Total Wellness (PDF)
RX Navitus Customer Care 24-7 (PDF)
Solera 4 Me Diabetes Prevention Program (PDF)
Value-Based Purchasing - Hospital Limit for Outpatient Procedures (PDF)
Eden Virtual Primary Care (PDF)
Hinge with HSA Information (PDF)
MDLive Medical $10 Copay (PDF)
Kaiser Documents
Plan Comparisons
Comparación de Planes en Español
$0 Office Visits, $5 Prescriptions (xlsx Espanol)
$10 Office Visits, $10 Prescriptions (xlsx Espanol)
$10 Office Visits, $10 Prescriptions with Optical (xlsx Espanol)
$20 Office Visits, $10 to $20 Prescriptions (xlsx Espanol)
$20 Office Visits, $10 to $20 Prescriptions with Optical (xlsx Espanol)
$30 Office Visits, $10 to $30 Prescriptions (xlsx Espanol)
$30 Office Visits, $10 to $30 Prescriptions with Optical(xlsx Espanol)
DHMO $500 with Optical (xlsx Espanol)
DHMO $1,000 with Optical (xlsx Espanol)
Kaiser Forms
2024-2025 Existing Member Change Form (doc)
2024-2025 Existing Member Change Form (PDF)
Kaiser Permanente Senior Advantage Application (PDF)
Kaiser Permanente Believe Me Policy Template (docx)
Medicare Supplemental Disenrollment Form (PDF)
Termination of Subscribers - Maintenance Activity Report (PDF)
Transfers - Maintenance Activity Report (PDF)
SISC III Medical, Dental, & Vision Address Change Form (PDF)
Kaiser Benefit Summaries
These are summaries of the most frequently asked-about benefits. These charts do not explain benefits, Cost Share, out-of-pocket maximums, exclusions, or limitations, nor do they list all benefits and Cost Share amounts.
October 2024 to September 2025
$0 Office Visits, $5 Prescriptions (PDF)
$0 Office Visits, $5 Prescriptions with Optical (PDF)
$10 Office Visits, $10 Prescriptions (PDF)
$10 Office Visits, $10 Prescriptions with Optical (PDF)
$20 Office Visits, $10 to $20 Prescriptions (PDF)
$20 Office Visits, $10 to $20 Prescriptions with Optical (PDF)
$30 Office Visits, $10 to $30 Prescriptions (PDF)
$30 Office Visits, $10 to $30 Prescriptions with Optical (PDF)
Resúmenes de Beneficios de Kaiser Permanente en Español: Octubre 2024 a Septiembre 2025
$0 Office Visits, $5 Prescriptions (PDF Espanol)
$10 Office Visits, $10 Prescriptions (PDF Espanol)
$10 Office Visits, $10 Prescriptions with Optical (PDF Espanol)
$20 Office Visits, $10 to $20 Prescriptions (PDF Espanol)
$20 Office Visits, $10 to $20 Prescriptions with Optical (PDF Espanol)
$30 Office Visits, $10 to $30 Prescriptions (PDF Espanol)
DHMO $500 with Optical (PDF Espanol)
DHMO $1,000 with Optical (PDF Espanol)
$0 Senior Advantage Plan (PDF Espanol)
$25 Senior Advantage Plan (PDF Espanol)
Kaiser Summary of
Benefits & Coverage
The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan would share the cost for covered health care services. NOTE: Information about the cost of this plan (called the premium) will be provided separately. This is only a summary.
October 2024 to September 2025
$0 Office Visits, $5 Prescriptions (PDF)
$10 Office Visits, $10 Prescriptions (PDF)
$10 Office Visits, $10 Prescriptions with Optical (PDF)
$20 Office Visits, $10 to $20 Prescriptions (PDF)
$20 Office Visits, $10 to $20 Prescriptions with Optical (PDF)
$30 Office Visits, $10 to $30 Prescriptions (PDF)
DHMO $1,000 with Optical (PDF)
Kaiser Value-Added Services
Center for Healthy Living Core Program (PDF)
Explore Healthy Resources (PDF)
Getting Started with Video Appointment (PDF)
Healthy Balance Weight Management (PDF)
HSA High Deductible Paying For Care (PDF)
Telehealth - Skip the Trip (PDF)
Kaiser Mental Health
Health Savings Account Information
COBRA Documents
COBRA Forms
COBRA/Retiree Notification Form (PDF)
FAQ COBRA Continuation Health Coverage for Workers (PDF)
2024-2025 Plan Comparisons
COBRA Blue Shield PPO Rates (PDF)
Benefit Summaries &
Summary of Benefits and Coverage
Benefit Summaries & Summary of Benefits and Coverage can be found under the listing for each specific program: Medical, Dental, and Vision.
Notices & Rights
Annual Notices 2024 to 2025 (docx)
RESIG Privacy Practices Notice (PDF)
Medical Program Overview
RESIG’s broker, Alliant Insurance Services, negotiates with health benefit program carriers on an annual basis. The current plan period is October 1, 2023, to September 30, 2024.
The Health Program includes Kaiser Permanente and Blue Shield plans sponsored through Self-Insured Schools of California (SISC). Kaiser Permanente includes HMO plans and High Deductible Health Plan (HDHP) compatible with a Health Savings Account (HSA). Blue Shield health plans include PPO plans including an HDHP compatible with an HSA. The HSA plans are administered by RESIG.
Two Kaiser Permanente Senior Advantage (KPSA), two Blue Shield PPO 65+ and an Anthem Blue Cross Medicare supplemental (CompanionCare) plans are available for retirees over age 65 with Medicare Parts A & B or retirees who are Medicare-eligible prior to age 65.