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Dental-Vision Plan Open Enrollment

Open enrollment to make changes in dependent coverage for Dental-Vision Plan is now through December 5, 2020. You may choose to opt-in, opt-out or change your dependents during this time. Open enrollment forms are only required if someone is making changes for 2021.

Please note there is no premium rate change for calendar year 2021.

Please use the blank form below to make your “pre-tax” election for any health or dental-vision coverage  during 2021. If you do not have CCSD sponsored Health or Vision-Eye Care Insurance, then no form is necessary.

Please submit your dental-vision change forms to payroll by December 5, 2020 and your Salary Redirection form to payroll by December 31, 2020.

2021 Blank Salary Redirection/Reduction Agreement