2023 Rate Sheets
Effective January 1, 2023 (beginning with your December 2022 paycheck)
Benefits Analyst
Phone: 510-317-4622 
Risk, Safety & Benefits Manager
Phone: 510-317-4647
Health Benefit Plan Enrollment Form:

CalPERS Health Plan Information

Online tools to find CalPERS health plans available in your area:

Health Plan Search by Zip Code

Glossary of Health Coverage & Medical Terms provides standard definitions of terms commonly used in health insurance coverage:

CalPERS Health Plans Contact Information


Contact your individual health plan for the following items, questions or requests:

  • Evidence of Coverage (EOC) Books
  • Identification Cards
  • Benefits, Deductibles, Limitations & Exclusions
  • Service Area Boundaries
  • Individual Conversion Policy
  • Change primary care physicians or medical group
  • Certificate of Creditable Coverage

2023 Summary of Benefits and Coverage Notice
Choosing your health plan is an important decision. To assist you with this process, each health plan available through the California Public Employees’ Retirement System has produced a Summary of Benefits and Coverage (SBC). In addition, the federal government has compiled a glossary of common health insurance terms. Together, these documents provide important information to help you better understand your health benefit coverage and more easily compare health plan options.

To view the SBCs and glossary online, visit on the Plans & Rates page (subsection Health Plans), or visit any of the health plan websites below. To request a free paper copy of the SBC and glossary, contact each health plan directly.

Dental Plans

Delta Dental of California 
Delta Dental Customer Service
P.O. Box 997330
Sacramento, CA 95899-7330

There are no membership cards for Delta Dental.  Give your provider your SSN & DOB.


Spouses/Domestic Partners and IRS Dependent children up to age 25 are eligible to enroll in Delta Dental.


PPO Plan Summaries:

Understanding Your Delta Dental Benefits

Vision Plans


This vision plan is for CSEA, SEIU, SLMA, Supervisory & Confidential employee groups.

SLEA (Teachers) DO NOT HAVE A VISION EYE WEAR PLAN Effective January 1, 2011

Vision Service Plan
Member Services

There are no membership cards for VSP.  Give your provider your SSN & DOB.

Spouses/Domestic Partners and IRS Dependent children up to age 25 are eligible to enroll in VSP.

Understanding Your Vision Service Plan (VSP) Benefits
Employee Assistance Program (E.A.P.)
The Claremont Employee Assistance Program (EAP) is available for employees and family members of San Lorenzo USD. The Claremont Employee Assistance Program helps you resolve personal issues before they become more serious and difficult to manage. You and your eligible family members can receive professional, confidential counseling at no cost. Claremont also provides access to resources that can help you address virtually any personal concern or question.


Who provides the EAP? Claremont is a firm of select professionals who can help you with life’s challenges. You will be referred to a conveniently located counselor or resource with expertise in your area of concern.


Who will know? The EAP is a confidential service. Claremont understands the importance of maintaining your privacy. Your involvement with Claremont is afforded the maximum confidentiality permitted under the law.


At what cost? There is no cost to you or your covered dependents for EAP services, however, all services must be pre-authorized by Claremont.


What’s the first step? Call 800-834-3773 to discuss your question or issue with an experienced counselor who will refer you to the resources most appropriate for your needs.


Click on flyer links below to access more information about San Lorenzo USD's Employee Assistance Program: 

Retirement Information

For certificated employees:
For classified employees:
1-888-CalPERS or 1-888-225-7377

American Fidelity Assurance Flex Plans

To inquire about your Dependent Day Care or Medical Reimbursement accounts or claims contact:
American Fidelity Assurance Company
ATTN: AFES Flex Account Administration
P O Box 25510
Oklahoma City, Oklahoma 73106
Voice: 800-325-0654
Fax: 1-800-543-3539

To access reimbursement forms, click on the link below:

Flex Accounts Reimbursement Forms

Frequently Asked Flex Plan Questions (below)

Information on other voluntary plans call 1-800-662-1113

Tax Sheltered Annuity Plans (TSA)

San Lorenzo Unified School District is pleased to announce that enhancements have been made to the 403(b) Salary Reduction and 457(b) Participant Agreement (SRA) process. Effective January 1, 2022 election requests will be submitted through an online system.  This system is provided by our 403(b) and 457(b) Plan Administrator, Envoy Plan Services, Inc. The online process allows 24-hour access for employees. All approved representatives of the District’s authorized investment provider companies will be able to assist employees with this online process.


There are many benefits to the new SRA process:


  • Employees simply visit Online SRA System ( to access the online system.
  • The system can be accessed 24 hours a day, 7 days a week.
  • Employees can start, change, or stop a 403(b) and/or 457(b) SRA at their convenience.
  • Employees receive immediate online confirmation that their request has been submitted.
  • Authorized Investment Provider Agents/Representatives can assist employees.
  • A list of authorized Investment Providers is available at


Employees should utilize the below instructions to successfully utilize the online Salary Reduction Agreement process:

  1. Before completing the online Salary Reduction Agreement process, you MUST have an account established with the authorized Investment Provider of your choice.
  2. Navigate to the secure website Online SRA System ( Example 1Note that the SRA information entered via the online system will supersede and replace all prior 403(b) and/or 457(b) elections including the amounts, investment providers, and effective dates. Any election(s) you want to continue must be reflected or the election will be stopped.
  3. Employee Certification – You must confirm that you are eligible to participate in your employer’s plan. You will also be confirming that you have established your account under your employer’s plan with one of the Authorized Investment Providers. Click “Confirm” and then click “Submit”.
Envoy Example2


Employer and Participant Information – If you have previously entered SRA information or Envoy Plan Services has your demographic information archived in their system, most of your personal information will pre-populate.  If your information is not currently in Envoy Plan Services’ system, you will be able to add your record. Depending on the information displayed, be prepared to enter the following information:


    • Employer’s State
    • Employer’s Name
    • Employee’s Social Security Number
    • Employee’s Date of Birth
    • Employee’s Name, Address, and Telephone Number
Envoy Example 3
   5.  Salary Reduction Agreement Information – You have the ability to start, change, or stop contributions. If you want to maintain an existing contribution(s), you will need to enter the information for that contribution in addition to any other changes you are making. Be prepared to enter the following information:


    • Effective Date of the contribution(s)
    • The total dollar amount per pay period for all contributions
    • The investment provider(s) to whom you would like to contribute
    • The Plan type
    • The amount of a previous contribution, if any – not required to submit
      • This information can be found on your pay check stub, you can also call Envoy Plan Services (contact information provided at the bottom of this communication), or by checking with your investment provider directly
    • The new amount of your contribution

 Envoy Example 4

     6. Salary Reduction Agreement Terms and Disclosures – Once you have clicked Finished, you will be asked to read and confirm that you have read the SRA terms. You will also be asked to acknowledge the SRA disclosures.


    7.  Submitting your SRA – After completing the terms and disclosures sections, you will be asked to confirm that you are not a robot, and then you can submit your SRA. Envoy Plan Services will forward your contribution information to us, and you can print a copy of the SRA for your records.  Providing your account(s) is established with your investment provider, no further action is required.


Should you have any questions regarding the process, please contact Envoy Plan Services SRA Department at 800-248-8858, option 1.



AXA/Equitable Voluntary Term Life Insurance

Accidental Death & Dismemberment Insurance (AD&D)
Accidents occur everywhere, in airlines, in trains, in automobiles, on the job, in the home and in sports activities.  In the fact of such tolls, the prudent person finds that Accidental Death and Dismemberment insurance is of prime importance in a well-rounded financial program. It provides one’s family a financial bridge over the gap that occurs when a breadwinner meets accidental death, or an accident occurs, resulting in the loss of sight or dismemberment. In addition, it provides a sum that may be needed to train one for a new career.
Accidental death often finds the deceased’s estate in an unprepared condition. Assets may be less liquid than desired. Accidental Death and Dismemberment Insurance may be used to provide the additional sum needed to counter these conditions. We are pleased to offer this program of Accidental Death and Dismemberment insurance. We urge each of you to examine your own individual or family needs and consider this program.
All full-time employees under age 70 are eligible to participate. An employee who works an average of at least 20 hours per week is considered full-time.
Under the Family Plan, you may insure your family members as follows:
Your spouse if under age 70 and your unmarried dependent children (including step, foster, or legally adopted children) under age 19 years of age — or until age 23 if the child is a full-time student at school and primarily dependent on your for support and maintenance.
NOTE: If you are covered as an employee, you cannot be covered as a dependent.

Under this plan, you are covered 24 hours a day anywhere in the world, whether you are at home or on the job. You are also covered when traveling on business or for pleasure, including when you are flying as a passenger (but not as a pilot or crew member) in any civilian, public or military transport aircraft, except those owned, operated or leased by or on behalf of the policyholder. The benefits provided under this plan are payable in addition to any other insurance which may be in force at the time of loss.
Ask the Benefits Department for more information including rates for this plan.