Enrollment Forms

Kaiser
• .5000 and Above Load Kaiser Affidavit 11/12
• .4000 - .4999 Load Kaiser Affidavit 11/12
• Kaiser Enrollment form - NEW applicants
• Universal Enrollment form - PTF (use for NEW enrollees, REINSTATED enrollees, or those making changes to their current enrollment/dependents from 2010/2011.)

EPO/PPO Medical Plans - Self-funded Options
• If you reside outside of the State of California, you may enroll in one of the District’s Self Insured Medical Plans. Please click on the links for enrollment instructions:
  • The Exclusive Provider Organization (EPO) Medical Plan, or
  • The Preferred Provider Organization (PPO) Medical Plan