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Employee Benefits

General Summary, Information & Forms for City Participants

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General Insurance

City of Chico 2020 Benefits Guide - Active Employees
City of Chico 2020 Benefits Guide - Retirees & COBRA

Applications/Change Forms

Benefits Application & Change Form - Active Employees
Medical Opt-Out Form & Certification of Other Coverage

ACA Regulations & Important Guidelines
Preventive Services Covered under the Affordable Care Act
Glossary of Health Coverage and Medical Terms
American Heart Association Flyers
Premium Assistance Under Medicaid and the Children's Health Insurance Program (CHIP)

Anthem Blue Cross Medical Insurance

Anthem Customer Service
Customer Service: (800) 967-3015
www.anthem.com/ca/EIAHealth

Plan Summary of Benefits &
Coverage (SBC)
EPO 2020 EPO SBC
HDHP 2020 HDHP SBC
PPO 80/20 2020 PPO 80/20 SBC
PPO 90/10 2020 PPO 90/10 SB

Anthem Blue Cross General Information
How to Find a Provider Instructions
Anthem Claim Form
Take Care of Yourself - Preventative Services
Anthem Special Services Flyers
Anthem Live Health Online Flyer
Anthem Temporary ID Card Instructions
Anthem Blue Cross Online Resources
Anthem Blue Cross Drug Formulary
Anthem Specialty Pharmacy (HDHP)

Express Scripts
Customer Service: (800) 711-0917
https://www.express-scripts.com/
Medco Frequently Asked Questions
Medco Mail Order Form
Medco Claim Form

Carrum Health
Customer Service: (888) 855-7806
my.carrumhealth.com/EIAHealth
Carrum Flyer
Carrum What to Expect
Carrum Frequently Asked Questions

Sterling Health Savings Account (HSA)
Customer Service: (800) 617-4729
CustomerService@SterlingHSA.com
www.SterlingHSA.com
2021 Sterling Enrollment Form 
Sterling HSA Salary Redirection Form (Payroll Change Form)
Sterling Change Of Account Form

Delta Dental Insurance
Customer Service: (800) 765-6003
www.deltadentalins.com
Delta Dental SBC
Find a Network Dentist

Delta Dental Dentist Directory
Delta Dental Informational Flyers
Delta Claim Form
Where's My Dental ID Card?

VSP Vision Insurance
Customer Service: (800) 877-7195
https://www.vsp.com/
Where's my VSP ID Card? Plus other FAQs.
VSP Member Accounts Online
VSP Schedule of Benefits
VSP Primary Eyecare
Exclusive VSP Rebates & Special Offers
VSP Tru Hearing member Discount
VSP Out Of Network Claim Form

Employee Assistance Plan (MHN)
Customer Service: (800) 322-9707
www.mhn.com
MHN Informational Flyer
MHN Legal Services Flyer
MHN Financial Services Flyer
MHN Evidence of Coverage

Section 125 Flexible Benefits Program (Basic Pacific)
Customer Service: (800) 574-5448
customerservice@basicpacific.com
www.basicpacific.com
Flexible Spending Account Calculator
CBA Welcome Packet
Section 125 Summary Plan Description
Section 125 Reimbursement Form
Section 125 Dependent Care Reimbursement
Section 125 Direct Deposit Enrollment

CalPERS Retirement
Customer Service: 888-CalPERS (or 888-225-7377)
www.calpers.ca.gov
CalPERS Beneficiary Designation
Planning Your Service Retirement (Pub 1)
Service Retirement Application (Pub 43)
Retirement Allowance Estimate Request (BSD-470)
Local Miscellaneous Benefits (Pub 8)
Local Safety Benefits (Pub 9)
Service Credit Purchase Options (Pub 12)
Power of Attorney (Pub 30)
Community Property Guide (Pub 38A)
CalPERS Pension Worksheet

ICMA Deferred Compensation
Mark Tomasini, Retirement Plan Specialist
(866) 749-5180
www.icmarc.org
mtomasini@icmarc.org
ICMA Enrollment Form
ICMA Contribution Change Form
ICMA Fund Investment Listing
ICMA Beneficiary Designation Form
ICMA Direct Rollover Packet
ICMA Pre-Retirement Catch Up Form
ICMA Withdrawal Packet

Lincoln Financial Group Life and Disability Insurance
www.LFG.com
Summary of Life Insurance Benefits
Lincoln Disability One
Lincoln LifeKeys Flyer
Lincoln Travel Connect Flyer
Life Insurance Beneficiary Designation
Short Term Disability Claim Form
Lincoln City Paid Life and AD&D Policy Certificate
Lincoln Voluntary Life Policy Certificate
Lincoln Voluntary AD&D Policy Certificate

Aflac
Adam Brubaker
(530) 949-3767
​adam@leftoutins.com
www.aflac.com/chico

Modifying Elections

After medical, dental, vision, and flexible spending account elections are made, Internal Revenue Service (IRS) regulations generally permit changing those elections only during the next open enrollment (October of each year). However, if you experience a “qualifying event” during the year you may change certain benefit plan elections mid-year. The Human Resources & Risk Management Office must be notified of a qualifying event within 30 days of the event in order to make changes to your elections. No exceptions to the 30 day notification deadline are permitted. A qualifying event allows you to add or remove yourself or dependents from the City’s health plans, but does not allow you to change the plan you are enrolled in. Changes to the plan you are enrolled in may only be made during the City’s Open Enrollment Period, to be effective the first of the following year. At the time the change is requested you may be required to submit proof of the qualifying event or evidence of other coverage.

Benefits Summaries

Core Benefits Available

CalPERS Retirement Medical (4 plan options)
457 Deferred Compensation Dental + Orthodontic Benefit
Short Term Disability Vision
Long Term Disability Flexible Spending Account
Employee Assistance
Program
Group & Voluntary Life Insurance

Time Off Benefits

Vacation Sick Leave
Paid Holidays Military Leave
Bereavement Leave Jury Duty Leave
Personal Time Off/
Management Leave*
Maternity/Paternity Leave

*Eligibility Depends on bargaining unit and position.

Historical Summary of Employee Benefits - by Union

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