Health Benefit Forms
Below are the health benefit enrollment forms for new full-time employees and for current full-time employees who would like to make changes to their health benefit enrollment.
Dependent Changes During Open Enrollment
The 2026 Open Enrollment period is September 14 - October 9. Changes made during Open Enrollment will take effect January 1, 2027 through December 31, 2027. Full-time employees making dependent changes may do so with American Fidelity*.
Employees making dependent changes must also provide any necessary documentation to Human Resources. You can submit your verification documents to Human Resources by completing the Change to Health Benefits Form and uploading your documents directly to the electronic form.
To make dependent changes employees must complete the following:
- Add or remove your dependents with American Fidelity.
- Submit verification documents by completing the Change to Health Benefits Form.
Change to Health Benefits Form
Voluntary Benefit Plans
There are optional coverage benefits available that you can choose from to provide additional financial protection or supplement your health benefits:
- Tax Shelter Annuity Contributions
Learn more about Tax Shelter Annuity options by visiting the Payroll website. - Legal/ID Shield
Sign up for legal and/or ID shield services by submitting the Employee Benefit Member Application. - Section 125 Flexible Spending Plans (FSA)
Contact American Fidelity to enroll or learn more about FSA Plans within 30 days of your start date.
Peter Morse
Sr. Account Manager, American Fidelity
(951) 600-0122
E-mail Peter Morse
Phyllis Scotton
Account Representative, American Fidelity
(949) 310-8949
E-mail Phyllis Scotton
Life Event Changes
The following forms should only be used for benefit plan changes outside of the annual open enrollment period.
- Medical, Dental, & Vision
Employees with a qualifying event that impacts their health benefit enrollment (such as divorce or the birth of a baby) can make changes using the Change in Employee Health Benefits Enrollment Form. - Life Insurance Beneficiary Change
Complete the Life Insurance Beneficiary Change Form to change the beneficiary you have on file. - Legal/ID Shield
Submit the Employee Benefit Member Application to sign up for legal and/or ID shield services.
For more information please e-mail Employee Benefits
* American Fidelity serves as Cerritos College's third-party administrator for Section 125 Flexible Spending Accounts (FSAs) and voluntary supplemental insurance benefits, while also assisting the District during annual Open Enrollment.