The JLMBC is pleased to offer the following quality health benefit plans to eligible employees and their dependents, beginning January 1, 2010:
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Medical |
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2012 Prescription Drug Changes - Anthem Blue Cross New! |
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2012 Prescription Drug Changes - Blue Shield New! |
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2012 Prescription Drug Changes - Kaiser New! |
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Frequently Asked Questions About Medicare (link will take you to Medicare.gov website) New! |
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Need to contact CalPERS regarding long-term care? New! |
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CalPERS Prescription Drug Program Changes for Plan Year 2012 New! |
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CalPERS 2012 Health Benefit Summary |
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CalPERS 2012 Health Program Guide |
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2012 PERS Choice Basic and Medicare EOCs New! |
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2012 PERS Select Basic and Medicare EOCs New! |
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2012 PERS Care Basic and Medicare EOCs New! |
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2012 Access+ HMO EOC New! |
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2012 Blue Shield NetValue EOC New! |
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2012 Kaiser HMO EOC New! |
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CalPERS Medical Benefits Changes for 2011 Please Read |
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CalPERS 60/90 Rule Please Read |
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Understanding your Health Plan Statement |
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Kaiser for CalPERS Members flyer  |
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Dental |
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Benefit Highlights for Delta Dental PPO |
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Delta Dental PPO- Using Your Plan |
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SafeGuard Plan Comparison Summary (2009 benefits continue for 2010) |
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General Benefits Information |
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2010 Summary of Rights |
| top of page |
| Premium Rates |
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2011 Dental, Medical and Vision Premium Rates |
Revised! |
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2011 and 2012 CalPERS Premium Rates - HMO and PPO |
New! |
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2012 CalPERS Combination Medicare/Basic Rates |
New! |
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2012 Dental and Vision Rates |
New! |
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| FSA and HRA |
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To view your FSA/HRA information, go to MySHPS and enter your user name and password. If you have never registered, simply click the "New Users - Register Here" button to begin. |
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FSA Calculator |
New! |
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How an FSA Works |
New! |
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Flexible Spending Accounts (Simply explains FSAs) |
New! |
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Legislative News: IRS Guidance Regarding OTC Expenses & Updated Information on the IRS Guidance Regarding OTC Expenses
Information related to the HRA and FSA, provided by SHPS, to take effect beginning 1/1/2011 |
Updated |
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General information about Flexible Spending Accounts |
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Flexible Spending Accounts (summary of both the FSA and the HRA) |
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Wells Fargo HRA |
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HRA Brochure (Information about your HRA) |
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HRA Cardholder Agreement |
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HRA Envelope |
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HRA Card Front |
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HRA Receipts Envelope |
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FSA and HRA Eligible Expense Guide |
Updated |
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FSA and HRA User Guide |
Updated |
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Swiping the HRA Card and Documenting Expenses |
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Managing Your FSA and HRA Spending Accounts |
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Letter of Medical
Necessity |
New! |
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How to use the FSA/HRA debit card
This video explains:
- What to do when you receive your card
- How to use the card
- Why it is vital that you keep your receipts
Important Note:
The debit card can also be used with the HRA account, and everything in the video will apply to the HRA except that the HRA does not have tax benefit for the individual employee as does the FSA.
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New Video! |
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Benefits of an FSA Account
This video explains:
- Benefits to the employee of an FSA Health and/or Dependent Care Account
- What expenses are covered
- How to maximize the benefit to yourself
Important Reminders:
These reminders should help you to determine whether to enroll in the FSA and, if so, for how much.
- The HRA is used first and then the FSA
- At the end of the year, any unused HRA balance will roll over and be added to that year's balance
- Unused FSA funds do not roll over; therefore, any unused FSA balance at the end of the year will be forfeited
Important Note:
The debit card can also be used with the HRA account, and everything in the video will apply to the HRA except that the HRA does not have tax benefit for the individual employee as does the FSA.
top of page |
New Video! |
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| General Forms |
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2012 Enrollment/Change Form |
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2011 Benefits Enrollment/Change Form |
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Blue Shield - Request for Continuity of Care |
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Blue Shield - Declaration of Disability for Overage Dependent Child |
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Blue Shield - International Claim Form |
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Blue Shield - Rx Claim Form |
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Blue Shield - Statement of Claim Form |
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Blue Shield - Disabled Dependent Form |
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Kaiser - Claim for Emergency Services Form |
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VSP Out of Network Reimbursement Form |
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Certification of Video Display Terminal Use |
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| Term Life Insurance Forms and Information |
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MetLife Rates and Information Updated |
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MetLife Application Updated |
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MetLife Beneficiary Designation Form |
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| Domestic Partner Forms and Brochure |
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Affidavit |
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Tax Form |
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Terminating a California Registered Domestic Partnership |
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Declaration of Termination of Domestic Partnership (form) |
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