• Forms

     

  • Medical

    2019-2020

    For information on filing medical and prescription claims, please call Aetna at 1-800-222-9205.

    2020-2021

    Transition of Care Request  -  Contact BCBS at 1-866-355-5999
    • If you are currently in treatment with a doctor who is not part of the BCBS network starting September 1, a transition of care option may apply in certain situations (for example: treatment for cancer, terminal illness, third trimester of pregnancy, or cardiac rehabilitation).
    • If your transition of care request is approved, benefits will be paid at the in-network level for a specified period of time.

  • Vision

    Claim Filing Deadline:  Must be filed within 6 months from the date of service.
     
    VSP in-network optometrists will file claims for you.
     
    If you use a non-VSP optometrist, use your itemized receipt to complete the
    Out of Network Reimbursement form on the VSP web site
     
    Print the completed form and mail to:
    Vision Service Plan - Out of Network Provider Claims
    P.O. Box 997105
    Sacramento, CA 95899-7105 

  • Flex Accounts

    Claim Filing Deadline:  All flex claims and supporting documentation must be received by FBA no later than 90 days following the end of the plan year August 31, or 90 days following the termination of your account, whichever is earlier.
     
     
     

  • Life Insurance

    Life insurance changes can be made at any time during the year.
     
    To change your beneficiary:
     
    Complete the Beneficiary Change Form and return it to the PISD benefits department. Please review this FAQ about beneficiary designations.
     
    (If you also need to change the beneficiary on your TRS retirement account, the form is available on the TRS web site.) 
     
    To apply for new life insurance:
     
    1.  Complete the Application Form and return it to the PISD benefits department.
     
    2.  If needed, we will then send you a link to complete the online health questionnaire.
     
    Note: New employees applying for $250,000 or less within 31 days of hire will automatically be processed.
    All others will require the online health questionnaire.
     
    To cancel life insurance:
     
    Complete the Cancellation Form and return it to the PISD benefits department. 
     
    To increase life insurance amount:
     
    1.  Complete the Application Form to list the full amount that you want, and return it to the PISD benefits department.
     
    2.  If needed, we will then send you a link to complete the online health questionnaire.
     
    To decrease life insurance amount:
     
    Complete the Application Form to list the new amount that you want, and return it to the PISD benefits department. 

  • Disability Insurance

    To file a claim, call Cigna at 1-800-362-4462.