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For use by SAUSD Retirees Only
Use this form to enroll in the Blue Shield 65 Plus HMO plan.
Required Documents
A copy of the Medicare card for the individual enrolling.
For use by SAUSD Retirees Only
Use this form to enroll in the Kaiser Senior Advantage HMO plan.
Required Documents
A copy of the Medicare card for the individual enrolling.
For use by SAUSD Retirees Only
Use this form to enroll in or make qualified changes to your retirement benefits.
Required Documents
A copy of the County issued marriage certificate if enrolling a spouse for the first time.
A copy of the County issued birth ceritificate if enrolling a child for the first time.
A copy of a Medicare card if applicable.
Proof of loss of coverage if applicable
For use by Retiring Employees Only
Required Documents
Verification of your retirement through CalPERS/CalSTRS
(A copy of the first page of the application marked received by PERS/STRS or the award letter is accepted)
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