Enrollment Options and Information

• 2024 Medical Premiums
• 2023 Medical Premiums
• 2024 VEBA Benefit Choices
• Medical Enrollment Form

Medical Providers

United Healthcare (800) 624-8822

• Summary of Benefits
• Express Scripts (800) 918-8011 (UHC only)

Delta Dental (866) 499-3001 (Group # 7128-8018)

• Delta Dental Highlights
• Dental Enrollment Form
• Delta Notice of Privacy

VSP (800) 877-7195 (Group #00712201)

• VSP Highlights
• Vision Enrollment Form
• VSP/Costco Information
• VSP Notice of Privacy

Click on the logo below to visit the VEBA Resource Center.

United Behavioral Health Optum (888) 625-4809
Access Code: veba

EASE Employee Assistance Program
EASE Evernorth EAP Spanish Brochure Poster 2023
EASE Evernorth EAP Brochure 2023
EASE Evernorth EAP Registration
1 (888) 736-7009. well.evernorth.com

American Fidelity (800) 662-1113

• Flexible Spending Account
• Dependent Care Expenses

American Fidelity Claim Forms

• Accident Only Claim Form
• Cancer Claim Form
• Disability Claim Form
• Pregnancy Disability Claim Form
• Life Insurance Claim Form

Hyatt / MetLaw Legal Plan: (800) 821-6400  (Access Code:  1680005)

Empower Retirement
FBC/SDCOE Deferred Compensation Program
591 Camino De La Reina, Suite 530, San Diego, CA 92108

• 2021 Approved Vendor List
• SFFCU Contact Information
• Universal Notification Letter 403b and 457
• SFFCU Information
• SFFCU 403B Salary Reduction Agreement and Fax Coversheet
• SFFCU Planning Guide
• SFFCU 457 Salary Reduction Agreement