Valley Water Retirees Information

February 17, 2021 - March 12, 2021, For an April 1, 2021 effective date 

1. 2021 Information Memo

• Retiree Memo (Under age 65) 
• Retiree Memo (Over age 65) 

2. 2021 Open Enrollment Newsletter

3. Go Green! Open Enrollment/Evidence of Coverage Opt-Out Form 

• NEW! E-Sign and Submit this form online!

4. 2021 Plan Year Annual Notices

5. Retiree (Under age 65) Summary of Benefits and Coverage (SBCs)

• Blue Shield HMO
• Blue Shield PPO
• Kaiser HMO

6. Kaiser Enrollment Form (Under Age 65)

NEW! E-Sign and Submit these forms online!

• Kaiser Enrollment Form

7. Kaiser Senior Advantage Form (Over age 65)

• Please contact Benefits at [email protected] or (408) 630-3030)

8. Blue Shield Enrollment Form 

NEW! E-Sign and Submit these forms online!

• Blue Shield Enrollment Form

Blue Shield PPO/HMO Information 

www.blueshieldca.com  Group# W0051426

HMO: 1-855-599-2650 | PPO: 1-855-599-2650

• Blue Shield PPO EOC       
• Blue Shield HMO EOC
• Blue Shield Privacy Notice
• Blue Shield Hearing Aid Benefit
• Treatment Cost Estimator
• Grievance Form
• HMO Chiropractic and Acupuncture Benefit
• Prescription Benefits
• Prescription Mail Order Program

Kaiser Information www.kp.org, Group# 7189

1-800-464-4000

• Kaiser EOC
• Travel Benefits for Emergencies to non-Kaiser Facility
• Visiting Members to other Kaiser Regions
• Kaiser RX Mail Order

Delta Dental:(for eligible retirees only)

• Delta Dental (EOC)
• Group# 21266
• www.deltadentalins.com
• 1-800-765-6003

Vision Service Plan (VSP) (for eligible retirees only)

• Vision Service Plan (VSP) (EOC)
• Group# 30102594
• www.vsp.com
• 1-800-877-7195

Deferred Compensation

• Deferred Compensation Information

ARDE

• Association of Retired District Employees (ARDE)