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Employee Health & Welfare Benefits

Benefited Eligible Employees and their dependents are eligible to receive a comprehensive benefits package as offered by the Live Oak School District.

	PLAN OPTIONS
Medical	California's Valued Trust (CVT) offers the following plans to Eligible Employees: For Specific Health Benefit and Coverage Questions, please contact CVT Directly at 800-288-9870 PPO Bronze, Wellness, and High-Deductible Plans HMO Blue Shield HMO Trio 1 Kaiser See Dependent Verification information below
Dental	Dental plans are currently available through Delta Dental. Live Oak School District offers a variety of plan options including orthodontia and implants. Delta Dental Coverage Information Contact Delta Dental at 866-499-3001 or visit their website: DeltaDentalins.com
Vision	Vision Service Plan (VSP) is currently the provider for vision care. If the frames and lenses selected do not exceed the amounts paid by the plan, there will be no out-of-pocket expense. VSP Flyer Contact VSP at 800-877-7195 or visit their website: VSP.com
Life & AD&D	Standard Insurance Company is currently the provider for life insurance. The amount of life insurance coverage is determined by a unit members age. A unit member may purchase additional life insurance and AD&D at their own cost. Standard Insurance Company - Group Life Insurance - Employee Standard Insurance Company - Group Life Insurance - Administrators
Additional Benefits	Flexible Spending Account 125C Tax Shelter is available and offered by American Fidelity - For Questions, please email our American Fidelity representative, Dave Hume at Dave.Hume@americanfidelity.com Employee Assistance Program 457(b) and 403(b) Retirement Options

Dependent Verification

Dependent Verification

Important: Dependent Verification The District requires employees who enroll dependents in their medical, dental and/or vision insurance plans to provide documents to verify their dependents' eligibility for coverage. Your enrollment form must be accompanied with supporting documentation for your dependents.
Eligible Dependent Type	Eligible Dependent Definition	Required Documentation for Proof of Eligibility
Legal Spouse	Legally married spouse as defined by State law	Marriage License A signed copy of your your most recent Federal Tax Return of employee and spouse (blackout financial information) will also be accepted if marriage license is unavailable.
Registered Domestic Partner	Same-sex domestic partners, or opposite-sex domestic partners.	California Certificate of Domestic Partnership; or Completed Domestic Partnership Affidavit
Biological Child	Direct biological child under age 26	Government-issued Birth Certificate reflecting that the child is the employee's or spouse's child; or Most recent copy of tax return with signature of Employee/Spouse listing child as dependent (blackout financial information)
Step Child	Direct biological child (under age 26) from a spouse's prior marriage.	Government-issued Birth Certificate reflecting that the child is the spouse's child, AND Marriage License; or Government-issued Birth Certificate reflecting that the child is the spouse's child, AND signed copy of tax return of employee and spouse (blackout financial information)
Adopted Child	Adopted child under age 26	Government-issued Adoption Order, AND government issued Birth Certificate, or Foreign adoption approved by the INS or legal adoption documents from foreign country AND home government issued Birth Certificate
Guardianship Child	Persons under the age of 18 for whom you have legal guardianship	Court Order of Legal Guardianship, AND first page of Federal Tax Return (blackout financial information). Excludes temporary guardianship orders.
Disabled Child	Disabled child over the age of 26 for whom you have the legal responsibility to care	Notice of disability determination from medical carrier prior to attaining age 26 AND child documentation (biological/step/adopted/guardianship), or Notice of disability determination from the Social Security Administration prior to attaining age 26 AND child documentation (biological/step/adopted/guardianship)

Health & Welfare New Enrollment for New Employees and New Retirees 23-24 School Year.

New Plans and Rates will be effective October 1st

American Fidelity

Open Enrollment

Enroll in your Section 125 Benefits

Call: 866-504-0010 Ext. 0

H&W Enrollment Forms

22-23 New Employee & New Retiree Enrollment

Health Insurance

Dental and Vision

Life Insurance

COBRA

Cobra Dental & Vision Enrollment
Cobra Medical Rates (Information Only and may be subject to changes)

Please contact CVT Directly 800-288-9870 for actual COBRA medical plans and Rates