Open Enrollment Forms

  •  
    IMPORTANT
    Please take the time to read the information provided on this page carefully.
     
     
    Open Enrollment is passive this year.  If you want to keep your benefits the same, you don't have to do anything.  Any changes you make during this Open Enrollment will begin on July 1, 2024.
     
    Below is the Open Enrollment form you must complete in order to make changes to your plans for the 2024-2025 school year. 
     
    Your form will not be processed and will be returned to you if it is incomplete and/or supporting documents are not provided.
     
    Make sure to:
    1. Read the instructions provided on the form.
    2. Fill in all required fields, especially Social Security Numbers (collection of SSNs is required by the IRS).
    3. Provide all required documents (e.g., Copy of the County issued birth certificates for newly added children, copy of the County issued marriage certificate for newly added spouse).
    4. Keep a copy of your form for your records.
     
    Submit your Open Enrollment Form to our office by Friday, May 24, 2024
    Online
    Using the InformedK12 platform
    Online forms will receive a confirmation email once the form is reviewed.
     
     
     
    Email District Mail U.S. Mail Fax
    benefits@sausd.us Attention: Benefits
    Benefits Office
    1601 Chesnut Ave
    Santa Ana, CA 92701
    		 (714) 558-5682
    Emailed forms will receive a confirmation email once the form is reviewed.
    		 If you mail your form allow time for delivery.  If you would like confirmation that we have received your form, contact our office and leave us a message; we will return your message in the order it was received.
    		 Request a fax confirmation from your machine to use as verification of delivery.
     
     
     
Last Modified on May 10, 2024