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NEW: SAMPLE Anthem Enrollment Form for Staff
Sample form showing what needs to be filled out or skipped.
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2019-2020 Benefit Selection Link for Current SUSD Employees
Use the HelloSign link to select your benefits during Open Enrollment: https://app.hellosign.com/s/b22e056e
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Anthem Enrollment Form (updated for 2019-2020)
If you are choosing BOTH Vision and Medical, complete sections 1, 2, 3, 6, 7, 8, 9, 10, 11.
If you are choosing Medical only, complete sections 1, 2, 3, 6, 7, 8, 9, 10, 11.
If you are opting for Vision ONLY (no Anthem medical), see Vision section below on this page.
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NEW: SAMPLE Cigna Dental Enrollment Form
Sample form showing what needs to be filled out.
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Blue Vision Enrollment Form
If you are choosing BOTH Anthem Vision and Medical, complete sections 1, 2, 3, 6, 7, 8, 9, 10, 11.
If you are opting for Vision ONLY (no Anthem medical), select Vision on page 1 and complete sections 2, 3, 10, and 11.
