Enrollment Forms
Enrollment Forms
Electronic Benefit Enrollment Forms
Note: You will need to enter your name and email address when completeing the electronic benefit enrollment forms.
Cash In Lieu – Waive SUSD Medical
Dental and Vision
Parent-Child Relationship Affidavit
Electronic benefit enrollment forms are sent upon completion directly to the Benefits Analyst chosen before submission.
Eligible Dependents for SUSD Benefit Plans
- Spouse
- Registered Domestic Partner – current domestic partner registered with the California Secretary of State's Office.
- Tax Information: The cost of benefits for an enrolled domestic partner and children of the partnership is considered imputed income by the IRS. Imputed income is taxable and included in the employee's gross income, subject to federal tax withholding and payroll taxes.
- Children – includes natural born children, adopted children, stepchildren, and children of registered domestic partners.
- Disabled Children – children age 26 or older who have a mental or physical condition preventing them from supporting themselves.
- Parent-Child Relationship – children under age 26 for whom the employee has assumed parental status or duties, such as a grandchild, niece, or nephew.