Plan Summaries, Enrollment Forms and FSA Info

Please note that the below has been updated for Plan Year beginning January 1, 2020. If you need current plan information, please feel free to contact or view the applicable Benefit Guide below.

Synod of the Pacific’s Benefit Guide for Plan Year Beginning January 1, 2020

Medical/Dental/Vision PlansCalifornia Medical Plans
2020 Universal Enrollment FormSutter HMO SBC | Benefit Summary
Sutter Deductible HMO SBC | Benefit Summary
Kaiser HMO SBC | Benefit Summary | Chiro Summary
Kaiser HRA SBC | Benefit Summary
Voluntary Benefits
Reliance Life/AD&D Enrollment Form, Rates & Highlights
Section 125 FSAOutside California Medical Plans
2020 Section 125 FSA Enrollment FormKaiser NW SBC | Benefit Summary
Vantage Flex Smart Phone Claim Submission Instructions
Vantage Flex Portal Access and Online Claim Submission
2020 FSA Reimbursement Form
2019 Medical Reimbursement FormAnthem Dental Plans (with Life & EAP plan)
2019 Dependent Care Reimbursement FormAnthem High Dental Plan
2020 FSA Enrollment Information KitAnthem Low Dental Plan
2020 FSA Renewal LetterAnthem Life Insurance
2020 Summary Plan DescriptionResource Advisor Employee Assistance Plan
2020 FSA Main Plan Document
Vision (VSP)
Vision Service Plan