Benefits Department


    Form 1095-C for plan year 2020:   The Form 1095-C Employer-Provided Health Insurance Offer & Coverage, for the 2020 plan year is now available through Employee Online.  The form is located in the payroll information section, under tax forms for you to view and print.  The Form 1095-B Health Coverage which contains information on your covered dependents for the 2020 plan year, will be mailed to you directly from the insurance provider (i.e. Kaiser, Anthem, Blue Shield, HealtNet, Western Advantage, United HealthCare). 

  • Have a Life Changing Event?

    You only have 60-days from the date of:

    Loss/Gain of Coverage, Marriage/Domestic Partnership, Birth/Adoption of Child to notify the SUSD Benefits Department and make your benefit changes.  

    Benefit Enrollment/Change Forms you will need to complete and submit are located under the Enrollment Forms section.  Completed benefit enrollment forms and verification documents can be scanned/emailed to the Benefits Department at for processing. 

    Loss/Gain of Outside Health CoverageNeed proof of the loss/gain of outside health coverage: letter from the insurance carrier/employer, or COBRA notice that confirms the date you and any dependents lost/gained outside health coverage

    Marriage/Domestic PartnershipNeed Certified Marriage Certificate or State of California Domestic Partnership Certificate and Spouse/Partner's SSN card

    Birth/Adoption of ChildNeed certified Birth Certificate and Child's SSN card (NOTE: Certified Birth Certificate and SSN card take time to receive, so the Hospital issued Birth Certificate must be provided for the initial enrollment)

    DivorceNeed a copy of the stamped final divorce decree: the final date will end coverage at the end of that month 

    Death of DependentNeed a copy of the death certificate

    American Fidelity 

    Questions on your current policies, or to make changes/cancel your policies, please contact American Fidelity at 1-800-365-8306

  • Contact Information:

    To reach the Benefits Department, email them directly at


    Christine Vega

    Benefits Analyst

    209-933-7026 ext. 2030


    Breanne Maas

    Benefits Analyst

    209-933-7026 ext. 2039