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Forms are due to Judy Marty- HR Benefits Office as soon as possible in order to be processed. Medical Plan Election SISC Pool Plans Medical - Monthly Composite Rate KCCD Contribution Retiree Contribution 12 thly Month - Month Anthem PPO Kaiser HMO 100-A 20 Rx 5-20 1 455. Review the plan options available elect your plan by initialing the box below the plan you are electing then sign and date. 00 1 164. 00 291. 00 1 419. 00 255. 00 Rx 7-25 1 370. 00 206. 00 90-G 20 1 253. 00 89. 00 80-G 30...

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