Enrollment Forms

Enrollment Forms are now located under the Frequently Used Forms page. 

2023 Rate Sheets 

Effective January 1, 2023 - December 31, 2023

2023 SCTA Early Retiree Rate Sheet

2023 SCTA Over 65 Rate Sheet

2024 Rate Sheets 

Effective January 1, 2024 – December 31, 2024

2024 SCTA Early Retiree Rate Sheet

2024 SCTA Over 65 Rate Sheet

Dental Plans

Dental Dental Information

Premier Access Dental Information

2023 Dental Comparison Sheet

2024 Dental Comparison Sheet

Opt-Out Plan

Opt Out Bulletin & Reimbursement Request Form 2024

Basic Reimbursement Login Flyer