CZU PERSONNEL:

For Payroll or Personnel questions, contact Sr. Personnel Specialist Carla Delnegro
For Benefit questions, contact Office Technician Beth Snyder

 
FFI Separation Packet Forms
(Submit all completed, signed forms to Personnel upon separation.)
 
PERSONNEL FORMS
Employee Action Request
Std. 686

Used for Address and Withholding Changes
Emergency Notification Information
CDF 31

Used for Emergency Contact Information and Physician Designation
in the event of a Workman's Comp injury
 
Paycheck Calculator
Direct Deposit Form
Std. 699
 

Payday Calendar

Personnel Demob Form
BENEFIT ENROLLMENT FORMS
Health Enrollment - Form HBD 12
Used for Health Enrollments, Additions, or Deletions of
Employee and/or Dependents upon qualifying permitting event or Open Enrollment Period
Dental Enrollment - Form Std 692
Used for Dental Enrollments, Additions, or Deletions of
Employee and/or Dependents upon qualifying permitting event or Open Enrollment Period
 
VSP Premier Vision Enrollment
This is used for VSP Premier Enrollment, Additions, or Deletions of
Employee and/or Dependents upon qualifying permitting event or
Open Enrollment Period. *Basic vision coverage is automatic and does not require and enrollment form.
COBEN Cash Enrollment Form
Used for Flex Cash Enrollments, Additions, or Deletions of
Employee and/or Dependents upon qualifying permitting event or Open Enrollment Period for BU 7 & 8.
 
Flex Elect Cash Option Enrollment
Used for Flex Cash Option Enrollments for BU 1, 4, 12, & 13.
Additions, or Deletions of Employee and/or Dependents upon qualifying
permitting event or Open Enrollment Period
Flex Elect Dependent Care/Medical Reimbursement Enrollment
Used for Flex Dependent/Medical Reimbursement Enrollments,
Additions, or Deletions of Employee and/or Dependents upon qualifying
permitting event or Open Enrollment Period

Open Enrollment ended October 7, 2016
Changes made during Open Enrollment take effect:
January 1, 2017

Members can access CalPERS customized
Health Plan Statements online at my|CalPERS.

For assistance creating or logging in to your account, refer to:
How to Register for & Access my|CalPERS (PDF)

 

2017 Benefit Rate Calculator

2017 Health Plan Search by Zip Code

2017 Benefit Rates by Bargaining Unit

Be sure to look at the correct rate sheet for your Bargaining Unit.
You can complete the enrollment forms and mail or fax them to the HQ confidential fax at:
831-335-6714.

 

2017 Health Program Guide

2017 Health Benefit Summary

2017 Dental Handbook

2017 Open Enrollment Newsletter

CAL HR Dental Benefits

CAL HR Vision Benefits

CAL HR Flex Elect Benefits

 

REMINDER!!!
Health, Dental, and Flex Elect benefit enrollment changes
each require their own completed signed form for each type of benefit plan being modified.

These forms are contracts between the employee
and the state and require original signatures.

Changes cannot be made over the phone!

It is incumbent upon the employee to ensure that they have submitted
all of the necessary forms, listing all desired changes for each plan
in the timeframe allotted.

 Please mail your completed, signed forms to:
CZU Personnel

PO Drawer F-2
Felton, CA  95018

REMINDER!!!
Due to recent health care reform, dependent children can now be covered up to age 26
regardless of student, residency, or marital status.

In addition, social security numbers and proof of eligibility are now required for all dependents.

 

BENEFIT LINKS

Health Plan Websites

Dental Plan Websites

Vision Services Plan (VSP) Website

Flex Elect Handbook

 

The Work Number for Everyone
Used by employees to provide employment and salary verification
for lending agencies per CAL FIRE policy.
No verification is done through the Personnel office.
Instructions

 

Respiratory Protection Program (RPP)
The RPP Questionnaires have been mailed out to those permanent and limited term personnel
who are required to complete this information annually. Click here to learn more

 
2017 Holiday Schedule
Date Holiday
Monday, January 2 New Year's Day Observed
Monday, January 16 Martin Luther King Jr. Day
Monday, February 20 Presidents' Day
Friday, March 31 Cesar Chavez Day
Monday, May 29 Memorial Day
Tuesday, July 4 Independence Day
Monday, September 4 Labor Day
Friday, November 10 Veterans Day Observed
Thursday, November 23 Thanksgiving Day
Friday, November 24 Black Friday
Monday, December 25 Christmas Day
 

OTHER LINKS:

BARGAINING UNIT MOUs: http://www.calhr.ca.gov/state-hr-professionals/Pages/bargaining-units.aspx

BENEFIT ADMINISTRATION MANUAL: http://www.calhr.ca.gov/state-hr-professionals/Pages/benefits-administration-manual.aspx

STATE COMPENSATION INSURANCE FUND: http://www.statefundca.com/

EMPLOYEE ASSISTANCE PROGRAM: www.eap.calhr.ca.gov

SAVINGS PLUS NOW (401(k) & 457 Plans): https://www.savingsplusnow.com/
***SAVINGS PLUS FLYER
***

COLLEGE SAVINGS PLAN: http://www.scholarshare.com/

GROUP LEGAL:https://www.araggroup.com/

LONG TERM CARE: http://www.calpers.ca.gov/index.jsp?bc=/member/ltc/home.xml

THE WORK NUMBER FOR EVERYONE (Employment/Salary Verification): http://www.sco.ca.gov/ppsd_se_worknumber.html