HEALTH INSURANCE
OPEN ENROLLMENT September 1, 2021 through September 30, 2021

Health Insurance is administered by CALIFORNIA’S VALUED TRUST and provided by Anthem Blue Cross.

2021/22 Benefit Plan Matrix
Plan: WELLNESS, HDHP, BRONZE

2021/22 Benefit Plan Matrix
Plan: PPO 7C, PPO 8C, PPO 9C, PPO 10C

Premium Rates 2021/22
10 month/11 month/12 month

CVT MD Live

CVT Enrollment/Change Form

CVT Disabled Dependent Certification

CVT Declaration of Domestic Partnership

Termination of Domestic Partnership

PRESCRIPTION MEDICINE COVERAGE

CVS/Caremark Standard Claim Form

CVS/Caremark Secondary Claim Form

CVS/Caremark Mail Order Pharmacy Form

LAB SERVICES

LabCorp is the preferred provider for services in South Lake Tahoe and Nevada. LabCorp: 1625 SR88 #102, Minden, NV 89423  Tel: (775) 782-4532.

Quest Diagnostics is the preferred provider for services within California and outside South Lake Tahoe.

DENTAL INSURANCE

Dental insurance is administered by CVT and provided by Delta Dental. 

LTUSD’s Group# is 7901-3201

Member Assistance: (866) 499-3001 – Have your Group# and ID# ready

Dentist Referral: (800) 427-3237

Delta Provider Search

VISION INSURANCE

Vision insurance is administered by CVT and provided by Vision Service Plan (VSP)

LTUSD’s Group# is 21000491

Member Assistance: (800) 877-7195 Mon-Fri  5am-7pm PST

VSP Provider Search

LIFE INSURANCE

Vision insurance is administered by CVT and provided by MetLife
Forms can be obtained at www.cvtrust.org/resources/forms

Beneficiary Designation Form

RETIREMENT PLANS:

CAL STRS Link to Website

CAL PERS Link to Website

For questions about employee benefits, please contact:

Karla Aguirre
Tel: (530) 541-2850 ext. 1041
Email:  [email protected]