Retiree Benefits

If you are retiring from your active position, below are all the forms you will need:

• 2024-25 New Retiree Election Form
• 2024-25 Retiree Monthly Premium Rate Sheet (effective 10/01/2024)
• 2024-25 Plan Comparison - Retirees UNDER 65  
• 2024-25 Plan Comparison - Retirees OVER 65 or w/Medicare AB
  • Blue Shield Enrollment Form (if changing from Kaiser to Blue Shield)
  • Kaiser Permanente Senior Advantage (KPSA) Enrollment Form For any Kaiser members over 65 &/or with Medicare AB. IMPORTANT! Return enrollment form and copy of Medicare Card to BENEFITS! Do not send directly to Kaiser!!   
    • EXAMPLE: COMPLETED KPSA FORM
• Retiree Verification of Contact Information Form
• All About Your Retiree Benefits
• Setting Up Bill-Pay Instructions
• Address Change Form - Change mailing or legal address. Supplemental documentation may be required.
• SISC III Change Form - Name change or add/drop dependents - contact Benefits for regulations and requirements

Some forms are in the interactive PDF format. If further assistance is required, please contact the Benefits Office at (209) 575-6547.

• Address Change Form - Change mailing or legal address. Supplemental documentation may be required.
• SISC III Change Form - Name change or add/drop dependents; contact Benefits for regulations and requirements.

• RETIREE HEALTH PLANS
• RETIREE DENTAL/VISION PLANS

Retirees Over 65 - See Blue Cross CompanionCare Options for more information

For RETIREES BEYOND DISTRICT CONTRIBUTION - turning 65/70 and no longer eligible for District-paid Medical Plans:

You may CONTINUE your health insurance through the District if you pay the full premium.  For information on the new Blue Shield CompanionCare option, click here.

2024-2025 Retiree Monthly Premium Rate Sheet - Rates effective 10/01/2024

If you wish to CHANGE your health plan upon your retirement, please complete the New Retiree Election Form.  Otherwise, changes can only be made at Open Enrollment.

Exception:  You may switch to Blue Shield CompanionCare at any time with a 45-60 day notice.  If you make this switch, you can only switch back to a District Plan at Open Enrollment.

Remember that any premiums are due by the 1st of every month.  Checks should be made payable to: YCCD and mailed to YCCD, Attn: Fiscal Services, PO Box 4065, Modesto, CA  95352.  Please write "Retiree Benefits" and the month for which you are paying in the memo line of your check.

Although we do not have the ability for you to pay online, here are the instructions for setting up automatic bill pay with your financial institution:  Bill Pay Instructions

• Navitus Pharmacy Benefit Information

• 2024-2025 NEW RETIREE Election Form
• Blue Shield PPO Enrollment Form
• Blue Shield PPO EGWP (over 65 w/Medicare A & B)
• Blue Shield CompanionCare Enrollment (over age 65/70)
• Kaiser Enrollment Form (Retirees Under Age 65)
• Kaiser Senior Advantage Form (KPSA) (Retirees Over age 65 &/or with Medicare A & B)
• Address Change Form (Change mailing or legal address. Supplemental documentation may be required.)
• SISC III Change Form (Name change or add/drop dependents - contact Benefits for regulations and requirements.)
• Blue Shield Claim Form
• Prescription Claim Form

Note: The following form is due in the Benefits Office by the 15th of the month prior to the termination month.  Account must be current at the time of request.

• Request for Termination of Benefits