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Benefits Forms & Documents
Below you will find links that will take you to various Benefits forms and documents.
- 海角社区Employee Benefits Guide
- 海角社区Benefits Eligibility Acknowledgement Form
- Health Insurance Declination - Waiver Form
- 海角社区Domestic Partner Affidavit
- 海角社区Annual Notices Packet
- Open Enrollment Announcement
- Summary of Premium Costs & Contributions for H&W
- Open Enrollment Presentation
- Kaiser Permanente Enrollment/Change Form
- Kaiser Permanente Summary Plan Description
- Kaiser Permanente Summary of Benefits Coverage
- Kaiser Permanente Evidence of Coverage
- Kaiser The Active & Fit Direct Program
- Kaiser Healthy Balance Weight Management Program No Cost
- Kaiser Center for Healthy Living Programs
- BC HMO Elements Bronze Plan Enrollment Form
- BC HMO Elements Bronze Plan Benefits Summary Plan Description
- BC HMO Elements Bronze Plan Summary of Benefits Coverage
- BC HMO Bronze Plan Elements Evidence of Coverage
- Blue Cross HMO Enrollment Form
- BC HMO Summary Plan Description
- BC HMO Summary of Benefits Coverage
- BC HMO Evidence of Coverage
- Blue Cross PPO Enrollment Form
- BC PPO Summary Plan Description
- BC PPO Summary of Benefits Coverage
- BC PPO Evidence of Coverage
- Express Scripts Home Delivery Order Form
- How to Use Mail Order Rx
- Prescription Drug Reimbursement/Claim Form
- Member Claim Form
- DeltaCare USA - Enrollment/Change Form
- DeltaCare USA - Evidence of Coverage
- Delta Care USA 鈥� Enrollee Notice
- Delta Dental PPO Enrollment/Change Form
- Delta Dental PPO Evidence of Coverage
- Delta Dental PPO Highlights
- How Delta Dental Incentive Plan Works
- Delta Dental PPO 鈥� Enrollee Notice
- VSP Summary-All
- 海角社区Group Term Life Enrollment/Beneficiary Change Form
- Anthem Blue Cross Basic Life and AD&D Summary Plan Description
- Anthem Blue Cross AD&D Certificate Booklet
- UNUM Basic Life & AD&D Summary
- UNUM Life and AD&D Booklet
- Savings & Retirement Plans through Schools First FCU
- Unum Instructions For Enrolling in Voluntary Products
- Unum Voluntary Short Term Disability
- Unum Long Term Disability
- Unum Voluntary Life and AD&D
- Unum Evidence of Insurability (medical questionnaire)
- Unum Voluntary Plans Beneficiary Form
- MetLife Beneficiary Form
- Retiree Annual Notices
- 海角社区Retiree Benefits Guide
- 海角社区Post-65 Retirees Benefits Guide
- EAP Service Summary
- EAP Brochure
- Benistar Medicare - 2023 海角社区
- Ray Martin & Associates '22 Medicare 101 - LBCC
- Welcome_to_kaiser_permanente_presenting_medicare_101_LBCCD
- LBCCD Bronze Plan Open Enrollment Announcement
- Bronze Plan Payment Terms Agreement
- Part-Time Employee Benefits Guide
- Cover Memo for CHI Benefits
- 海角社区PT Adjunct Faculty Medical Coverage Enrollment Announcement 2024
- PT Faculty Medical Insurance Information
- 海角社区Insurance Certification Form
- PT Faculty Enrollment Form - BC HMO Elements Bronze Plan
- BC HMO Elements Bronze Plan Benefits Summary Plan Description
- BC HMO Elements Bronze Plan Summary of Benefits Coverage
- PT Faculty GAP MONTHS
- Read more
Incident Reporting
Information Security Procedure
Information Security Procedures (ISPR) provide formal methods for which Information Security Regulations, Standards, and Best Practices are conducted.
This ISPR directly supports the ITS Incident Response Information Security Standard.
Office of Institutional Research Data Requests
Please submit your data request at least 10 business days prior to the date this data is needed. Please be aware that some data requests may take longer. Allow extra turn-around time if your request requires that we collect data from an external agency.
Data requests are prioritized according to institutional needs, and certain data requests may require additional approval.
Sexual Harassment Training
- Login to the Viking Portal
- Click on Keenan SafeColleges
- Scroll down to 鈥淚nterested in Extra Training?鈥�
- Click on 鈥淰iew Library鈥�
- In the 鈥淪earch鈥� box, enter 鈥淭itle IX鈥�
- Five courses come up with the search 鈥淭itle IX鈥�
- Indicate which course(s) you want them to complete.