Open Enrollment Forms

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    IMPORTANT
    Please take the time to read the information provided on this page carefully.
     
     
     If you want to keep your benefits the same, you don't have to do anything.  Any changes you make during this Open Enrollment will begin on July 1, 2025.
     
    Below is the Open Enrollment form you must complete in order to make changes to your plans for the 2025-2026 school year. 
     
    Beginning with the 2025–2026 school year, we will be implementing a new system for Open Enrollment.  All Active employees must log in to the designated system and complete their enrollment electronically. All retirees, please continue to use the Form provided.
     
    Active Employees:
    1. Click Here to obtain your User Name and Password for PlanSource
    2. Fill in all required fields, especially Social Security Numbers (collection of SSNs is required by the IRS).
    3. Provide all required documents (e.g., Copy of the County issued birth certificates for newly added children, copy of the County issued marriage certificate for newly added spouse).
    4. Your username and Password will be needed in the future if any changes need to be made to your coverage.
     
    Submit your Open Enrollment Changes to PlanSource by Friday, May 30, 2025
     
    Online
    Using PlanSource Portal
    Online forms will receive a confirmation email once the form is reviewed.
     
     
    Retirees:
     
    1. Please download the Retiree Open Enrollment Form
    2. Fill in all required fields, especially Social Security Numbers (collection of SSNs is required by the IRS).
    3. Please e-mail your forms to benefits@sausd.us Once reviewed, you will receive a confirmation e-mail that our office has received your submission. 
     
     
     
    Email District Mail U.S. Mail Fax
    benefits@sausd.us Attention: Benefits
    Benefits Office
    1601 Chesnut Ave
    Santa Ana, CA 92701
    		 (714) 558-5682
    Emailed forms will receive a confirmation email once the form is reviewed.
    		 If you mail your form allow time for delivery.  If you would like confirmation that we have received your form, contact our office and leave us a message; we will return your message in the order it was received.
    		 Request a fax confirmation from your machine to use as verification of delivery.
     
     
     
2025-2026 Open Enrollment Information
May 19, 2025 through May 30, 2025
Last Modified Today at 1:06 PM