OPEN ENROLLMENT FOR JANUARY 1, 2024
November 7-29, 2023
The 2024 Conference Health Benefits details for open enrollment are now available (as a single .zip file) for download on this Health Benefits page via the button below.
Please first carefully read the “2024 Cover Letter” document, which contains pertinent details on this year’s process.
To enroll, if you have previously waived the Conference enrollment or made plan changes or if you are adding or dropping any dependents for January 1, 2024, the deadline for submitting all forms to Rosa Garcia is November 29, 2023. Please email completed forms to email@example.com or fax them to 626.577.1620 no later than the due date. If enrollment forms are being submitted directly by the Clergy, please ensure that your church’s SPRC Church chair and Office Administrator are cc’d.
Note that incomplete forms may delay your enrollment, so please make sure you complete all highlighted areas on the form, which include your personal information and your dependents’ information (if applicable), as well as your plan election if enrolling in Medical or Dental. If the completed forms are received late, enrollment may be delayed and may be subject to review and approval from each of our carriers before becoming active. If a carrier denies the enrollment, you will receive an email advising you. The next opportunity to enroll will be during our next open enrollment. You will need to resubmit forms at that time for an effective date of January 2025.
If you are waiving the Conference Health Benefits starting January 1, 2024, please complete the Health Benefits Waiver form here. Once the declination form is fully completed and you hit the submit button, it will be routed electronically to the Benefits Office, and you will receive a copy.
For questions, contact Rosa Garcia (firstname.lastname@example.org; 626.568.7319), Health Benefits & Employment Administrator.
OR download each file:
- Medical: Kaiser Enrollment/Change Form (PDF)
- Vision: VSP Membership Enrollment/Change Form (PDF)
- Dental: Guardian Dental Enrollment/Change Form (PDF)
Plan Summaries & Rates:
- 2024 Medical, Vision, and Dental Rates (PDF)
- Kaiser HMO: Traditional Plan Summary of Benefits (PDF)
- Kaiser HMO: HSA High Deductible Health Plan (HDHP) Summary of Benefits (PDF)
- VSP Member Benefits Summary (PDF)
- 2024 Dental Side-by-Side Plan Comparison (PDF)
New Member Information:
- Kaiser New Member (PDF)
- Kaiser Care Away from Home (PDF)
- Dental Guardian: Find a dentist
- NOTE: When searching for a dentist, under Plan Type, select “Managed Dental Care (DHMO/Prepaid)” if you elected a DHMO plan OR select “PPO: Dental Guard Preferred” if you elected one of the PPO plans.
- VSP: New Member Letter (PDF)
- Vision VSP: Search for a provider
To waive the Conference health benefits during open enrollment or at any time of the year due to a qualifying event, please complete and submit the Declination form here.