Business Services / Payroll & Benefits
PAYROLL & BENEFITS
IRC125 2021 OPEN ENROLLMENT
2021 Open Enrollment for IRC125 IRC125 Unreimbursed Medical Expenses (Flexible Spending Accounts), Dependent Care Expenses, and/or Pre-tax medical premiums. To make changes, employees must enroll every year during the open enrollment period. IRC125 Pre-tax is Optional and is not an automatic enrollment! Your current voluntary deductions will not automatically roll over the following year. PLEASE DON’T MISS OUT! Last Chance, Last Day appointment is December 15, 2020! There will be no late enrollment allowed (no extensions, no exceptions) after the last date. American Fidelity Online Sign up for your guided virtual enrollment: https://benefits.americanfidelity.com/Milpitas-usd |
![]()
|
Health, Dental, and Vision Online Enrollment and Changes, go to https://www.workterra.net
Enrollment must be completed within 30 days of hire date/increase in work hours (permanent employees from <.50% to >.50+%FTE) or a qualifying (life changing) event outside the Open Enrollment month (e-mail notification from workterra Administrator@ebsbenefits.com).
Enrollment must be completed within 30 days of hire date/increase in work hours (permanent employees from <.50% to >.50+%FTE) or a qualifying (life changing) event outside the Open Enrollment month (e-mail notification from workterra Administrator@ebsbenefits.com).
Insurance Information
![]()
|
![]()
|

2021_Matrix Rates CSEA MTA MGMT |

2021 UHC vs. KP comparison & Dental and Vision Plan Summary |
![]()
|
Delta Dental In-network providers:
www.deltadentalins.com |
![]()
|
Vision Service Plan In-network providers:
www.vsp.com |

UHC Virtual Visit Costs as of 10-1-2020 |
![]()
|
![]()
|
Certificated Adult Ed (Elmwood & Ayer)
Benefits Eligibility requirement: permanent hours must be 24.50 hours per week or >.8166%FTE work hours per week ****
Certificated Adult Ed Staff Benefits Package: Kaiser Permanente with Delta Dental Rider (combined Kaiser and Delta Dental within the Kaiser plan) and Vision Service Plan. Cert Adult Ed are not eligible for a separate Delta Dental plan under CSEA/MTA/Mgmt. This is a special contract which has been established specifically for Adult Ed Certificated Staff.
Certificated Adult Ed Staff Benefits Package: Kaiser Permanente with Delta Dental Rider (combined Kaiser and Delta Dental within the Kaiser plan) and Vision Service Plan. Cert Adult Ed are not eligible for a separate Delta Dental plan under CSEA/MTA/Mgmt. This is a special contract which has been established specifically for Adult Ed Certificated Staff.
![]()
|
![]()
|
Insurance Carriers
United Healthcare (UHC): 888-641-9142 | www.uhc.com
Kaiser Permanente (KP): 866-454-8855 | www.kp.org Delta Dental (DD): 888-335-8227 | www.deltadentalins.com |
Vision Service Plan (VSP): 800-877-7195 | www.vsp.com
Insurance Broker Agency: JPA www.sccsig.org Broker: www.willistowerswatson.com |
Life Insurance Benefits for CSEA (permanent >.50%+FTE) Employee Only
![]()
|
![]()
|

Blue Shield Life Ins Policy Contract_038034 |
Employee Assistance Program (EAP) Effective 05/01/2020
![]()
|
![]()
|
![]()
|
COBRA Continuation (optional, self-pay premium) must enroll within 60 days of eligibility period. COBRA is not an automatic enrollment:
FAQs on COBRA Continuation Health Coverage for Workers
FAQs on COBRA Continuation Health Coverage for Workers

2020 COBRA SELF-PAY Premiums |
Monthly Premium Calculation (MTA CTA, exclude MTA Adult Ed, CSEA and Management)
Work hours conversion into percentage: divide your 4 hours per day by 8 hours = 50% Full-time equivalent (FTE). This is your base to multiply from the district's medical cap (see example above), dental and vision premiums. Employee's monthly pro-rated contribution is the difference between monthly premiums minus Employer's = Employee's (see example below).
- 100% Full time employee (FTE) Medical Cap eligibility is up $971 (effective 01/01/2020)
- **Part time (between 50% and 99.99%), employee Medical Cap is pro-rated. For example, if employee works 4 hours or 50%, then, the medical cap is calculated as follows: $971.00 x 50% = $485.50 monthly District medical pro-rated contribution. Employee pays the difference between the district's and the premiums. ** Adult Ed calculation is based from 24.50+/.8166+% minimum per week
- 100% Full time employee Delta Dental and Vision Service Plan, the District pays for the monthly premiums
- **Part time (between 50% and 99.99%), Delta Dental and Vision Service Plan is calculated as follows: $Premium x .50% = district's monthly contribution. Employee pays the difference between the district's and the premiums. **
- CONVERSION (from hours to percentage) based on your job title and the required minimum hours to be eligible for benefits:
- CSEA Classified permanent work hours minimum requirement = 4 hours per day; 4 hours divided by 8 = 50% FTE; Full-time is 8 hours per day
- CDC Teachers permanent work hours minimum requirement = 3.5 hours per day; 3.5 hours divided by 7 hours per day = 50% FTE; Full-time is 7 hours per day
- Regular non-CDC permanent work hours minimum requirement = 3 hours per day; 3 hours divided by 6 hours per day = .50%; Full-time is 6 hours per day
- Adult Ed Certificated permanent work hours minimum requirement = 24.50 divided by 30 hours = 81.66%; Full-time is 6 hours per day
Work hours conversion into percentage: divide your 4 hours per day by 8 hours = 50% Full-time equivalent (FTE). This is your base to multiply from the district's medical cap (see example above), dental and vision premiums. Employee's monthly pro-rated contribution is the difference between monthly premiums minus Employer's = Employee's (see example below).
See the following pro-rated sample calculation based on .50%+FTE and Kaiser Single High plan.
- Please be advised that pro-rated contribution will be deducted from your normal pay check. If you do not have normal pay, you MUST remit your monthly contributions during those months to MUSD by the 1st of that month (usually during summer months, June-Aug, July, or July-August).
(A) Insurance Carrier |
(B) No. of Coverage |
(C) Monthly Premium Based from 2021 |
(D) Employer Monthly Based from 2021 Pro-rated premium for part-time .50%+ |
(E) Employee Monthly Based from 2021 (Premium minus Employer's = Employee's) (C-D=E) Pro-rated premium for part-time .50%+ |
Kaiser High Plan with Chiro (limited visits) Co-payment |
Employee Only |
$714.01 |
$485.50 ($971 x 50%) |
$228.50 ($714.01-$485.50) |
Delta Dental PPO Premium Plan (effective 01/01/2019) -Group Active #07102-11190 -Group COBRA #07102-11191 - MTA CTA/CSEA/MGMT with .50%+FTE (20 hrs/week) (Excluding Adult Ed Ayer & Elmwood) |
Employee Only Employee+1 Employee+Fam 3+members |
$64.72 $129.43 $218.81 |
$32.36 ($64.72 x 50%) $64.72 ($129.43 x 50%) $109.41 ($218.81 x 50%) |
$32.36 ($64.72-$32.36) $64.72 ($129.43-$64.72) $109.41 ($218.81-$109.41) |
Vision Service Plan (VSP) High (effective 01/01/2019) - Group Active #2931234A - Group COBRA #2931235A - MTA CTA/CSEA/MGMT with .50%+FTE (20 hrs/week) - CTA ADULT ED with .8166%FTE (24.50 hrs/week) |
Employee Only Employee+1 Employee+Fam 3+members |
$8.53 $17.05 $32.21 |
$4.27 ($8.53 x 50%) $8.53 ($17.05-$8.53) $16.11 ($32.21-$16.11) |
$4.26 ($8.53-$4.27) $8.52 ($7.05-$8.53) $16.10 ($32.21-$16.11) |
UHC Signature Value Full Network HMO Copay |
Employee Only |
$1,115.49 |
$485.50 ($971 x 50%) |
$629.99 ($1,115.49-$485.50) |
UHC Signature Value Advantage Canopy, Limited Network , Copay |
Employee Only |
$994.50 |
$485.50 ($971 x 50%) |
$509.00 ($994.50-$485.50) |
SCCSIG Wellness Challenges
Register and earn points (rewards) for participation in qualifying wellness activities: Santa Clara County SIG Employee Wellness Program
Questions, contact: HealthFitness Customer Service at CustomerService@hfit.com or 1-800-337-8508 |
Wellness registration "How To" videos
This is the smallest size, use for internet/website
|
720p – This is medium size, use for TV/digital displays
|
|
|
Payroll
EMPLOYEE SELF SERVICE (ESS)
To access your Copies of Milpitas USD Payroll Records, go to Employee Self Service (ESS).
If you need any help, click here to view the Instructions. |
FORMS
Certificated Payroll Forms - New Hire
![]()
|
![]()
|
Supplemental Retirement Account (Optional - Employee Only Contribution)
403(b)/457: https://tdsplans.org/
- MUSD 403(b)/457 Plan ID for brand new account set up: 50618
- Tax Deferred Solutions (TDS) is Milpitas USD's Third Party Administrator (TPA). They are in compliance with the IRS 403(b) and 457 regulations. They handle ALL transactions on behalf of MUSD (reviews, signs, and approves ALL current/previous employee's transaction request regarding rollover, transfer, withdraw or borrowing of funds). Send all requests to them. They will verify your employment period with MUSD. https://www.tdsplans.org/forms_PD.aspx?orgID=5841
- MUSD Federal Identification Number (FIN): 77-0289955
- IRS IMPORTANT YEARLY CONTRIBUTION LIMIT: https://www.irs.gov/retirement-plans/plan-participant-employee/retirement-topics-403b-contribution-limits

F-14 Employee Payroll Vol Deduction Changes |

Direct Deposit Agreement |
Federal Income tax (IRS): https://www.irs.gov/pub/irs-pdf/fw4.pdf
California Tax withholding (EDD D-4): https://www.edd.ca.gov/pdf_pub_ctr/de4.pdf

Deferred Pay (Optional) |

State Disability Ins (SDI) Acknowledgement |

Payroll Warrant Beneficiary Designation (P-9) |
Social Security Windfall Elimination (WEP):

Form_SSA-1945_5-2004 WEP |
Medicare
- Medicare Mandatory both employer/employee contribution (no form needed)
- Employee MUST enroll with Medicare Parts A & B and/or Part A only within 90 days of his/her 65th birthday. It's your choice.
- MUSD will continue your medical coverage as long as you are an active employee (in paid status). Contact the Social Security Agency local office, or go online to sign up for Parts A & B. If you do not sign up when eligible you may be fined the late enrollment lifetime penalty!
- https://www.medicare.gov/sign-up-change-plans/how-do-i-get-parts-a-b/part-a-part-b-sign-up-periods
CalPERS:
![]()
|
![]()
|

CalPERS Reciprocity Self-certification (info from previous employer) |
CalSTRS:

CalSTRS CalPERS RetirementSystemElection (for brand new hire teacher and a current CalPERS member) must choose one system |

CalSTRS Permissive Election Form-es0350_for certificated substitute employees waiving membership |

CalSTRS Express Benefit Report (HR Dept completes this form for retiring employees) |
Public Alternative Retirement Systems (PARS)
Permanent Classified CSEA employees with less than .50% FTE work hours per week
Certificated Substitute (on-call basis employees) waiving CalSTRS Membership Election
Certificated Substitute (on-call basis employees) waiving CalSTRS Membership Election

PARS Designation of beneficiary_complete If waive CalSTRS membership election |
Employee Bargaining Units
Certificated Employees:
- Milpitas USD Certificated President: Diana Orlando @ DOrlando@musd.org
- Milpitas Teacher Assoc'n (MTA)/California Teacher Assoc'n (CTA)
- https://www.cta.org/
- Dues forms: https://ctago.org/wp-content/uploads/2018/01/CTA-Certificated-Enrollment-FormK-12.pdf

MTA_SY 20/21_Membership_dues |
Classified Employees:
- Milpitas USD CSEA President: Machelle Kessinger @ MKessing@musd.org
- Classified School Employee Association (CSEA)
- https://www.csea.com/
Management:
- Milpitas Management Association President: Laurie Armino @ LArmino@musd.org
- Milpitas Management Association (MMA)
2020-2021 PAYROLL SCHEDULE DEADLINES

2020-2021 MUSD PAYROLL SCHEDULE PROCESSING DEADLINES |
Extra Work Permanent employee
Pay period from the 16th of previous month to the 15th of the current month is DUE every 15th of the current month (will be paid end of the current month). Must complete and submit a #P-20 time sheet . For all extra work (outside your normal work hours), the Principal/Secretary must submit F-12 prior to allowing employee to work the extra hours. F-12 for extra hours must match the exact hours on time sheet. Failure to complete F-12 for all extra work hours will delay in processing your paycheck. Payroll is unaware of employee's extra work hours. Therefore, it is the employee's responsibility to track all of his/her extra work hours and ensure with the Principal Secretary that all required paperwork has been completed and submitted to Payroll on time for payment.
F-12 permanent FTE employee, extra work (beyond normal position) must be completed prior
P-20 Time sheet for permanent FTE employee, extra work to be paid
Pay period from the 16th of previous month to the 15th of the current month is DUE every 15th of the current month (will be paid end of the current month). Must complete and submit a #P-20 time sheet . For all extra work (outside your normal work hours), the Principal/Secretary must submit F-12 prior to allowing employee to work the extra hours. F-12 for extra hours must match the exact hours on time sheet. Failure to complete F-12 for all extra work hours will delay in processing your paycheck. Payroll is unaware of employee's extra work hours. Therefore, it is the employee's responsibility to track all of his/her extra work hours and ensure with the Principal Secretary that all required paperwork has been completed and submitted to Payroll on time for payment.
F-12 permanent FTE employee, extra work (beyond normal position) must be completed prior
P-20 Time sheet for permanent FTE employee, extra work to be paid
![]()
|
![]()
|
Permanent Employee (Extra Work) Pay Period Time Sheet Deadline (Pay at the end of the Month)
> Extra Pay (extra work, in addition to your normal job), working outside of your normal job:
Any additional work must be pre-approved with an F-12 and must be submitted with a P-20 time sheet; ensure that the extra work is indicated on the time sheet accurately, write down completed extra work from the 16th of the previous month through the 15th of the current month. Extra hours will be paid at the end of the same month when they are received on the 15th of that same month. For example, use the month of August 16th to Sept 15th. You work from August 16th to Sept 15th. The time sheet is due on Sept 15th and will be paid at the end of Sept.
PLEASE REFER TO MUSD 20-21 PAYROLL SCHEDULE DEADLINES FOR EXTRA WORK DURING THE MONTHS OF NOVEMBER, DECEMBER AND JANUARY DUE TO THE HOLIDAYS.
Any additional work must be pre-approved with an F-12 and must be submitted with a P-20 time sheet; ensure that the extra work is indicated on the time sheet accurately, write down completed extra work from the 16th of the previous month through the 15th of the current month. Extra hours will be paid at the end of the same month when they are received on the 15th of that same month. For example, use the month of August 16th to Sept 15th. You work from August 16th to Sept 15th. The time sheet is due on Sept 15th and will be paid at the end of Sept.
PLEASE REFER TO MUSD 20-21 PAYROLL SCHEDULE DEADLINES FOR EXTRA WORK DURING THE MONTHS OF NOVEMBER, DECEMBER AND JANUARY DUE TO THE HOLIDAYS.
Affordable Care Act (ACA) Offer
Affordable Care Act (ACA) Offer (130 average hours per month)- Substitute, non-permanent and less than 50% permanent employees - must meet the 130 average hours per month during measurement period):
![]()
|
Marketplace Insurance (unaffiliated with MUSD)
Health Insurance Through Covered California: https://www.coveredca.com/
Questions about Covered California, contact them directly: https://www.coveredca.com/find-help/contact/
Milpitas USD disclaimer: Individual enrollment and coverage, if applied, is directly with the chosen carrier, not with Milpitas USD. We do NOT have insurance plans with the Covered California.
Questions about Covered California, contact them directly: https://www.coveredca.com/find-help/contact/
Milpitas USD disclaimer: Individual enrollment and coverage, if applied, is directly with the chosen carrier, not with Milpitas USD. We do NOT have insurance plans with the Covered California.
New Health Insurance Marketplace Coverage Options and Your Health Coverage
www.dol.gov/sites/default/files/ebsa/laws-and-regulations/laws/affordable-care-act/for-employers-and-advisers/model-notice-for-employers-who-offer-a-health-plan-to-some-or-all-employees.pdf
New Health Insurance Marketplace Coverage Options and Your Health Coverage:
https://www.dol.gov/sites/default/files/ebsa/laws-and-regulations/laws/affordable-care-act/for-employers-and-advisers/model-notice-for-employers-who-do-not-offer-a-health-plan.pdf
www.dol.gov/sites/default/files/ebsa/laws-and-regulations/laws/affordable-care-act/for-employers-and-advisers/model-notice-for-employers-who-offer-a-health-plan-to-some-or-all-employees.pdf
New Health Insurance Marketplace Coverage Options and Your Health Coverage:
https://www.dol.gov/sites/default/files/ebsa/laws-and-regulations/laws/affordable-care-act/for-employers-and-advisers/model-notice-for-employers-who-do-not-offer-a-health-plan.pdf
SUBSTITUTE TEACHERS & CLASSIFIED EMPLOYEES
Time sheet deadlines:
Substitutes (on-call) - pay period ( from the 26th of previous month to the 25th of the current month) DUE every 25th of the current month (will be paid the following tenth of the month). Must complete a #P-65 time sheet. The Principal Secretary must submit a P-16 (substitute long term contract) prior to allowing employee to work. P-16 is required for all substitute being contracted to work for certain length of time. Payroll is unaware of who works as a substitute. Therefore, it is the substitute's responsibility to track all of his/her work days/hours and ensure with the Principal/Secretary that all required paperwork has been completed and submitted to Payroll on time for payment.
Time sheet deadlines:
Substitutes (on-call) - pay period ( from the 26th of previous month to the 25th of the current month) DUE every 25th of the current month (will be paid the following tenth of the month). Must complete a #P-65 time sheet. The Principal Secretary must submit a P-16 (substitute long term contract) prior to allowing employee to work. P-16 is required for all substitute being contracted to work for certain length of time. Payroll is unaware of who works as a substitute. Therefore, it is the substitute's responsibility to track all of his/her work days/hours and ensure with the Principal/Secretary that all required paperwork has been completed and submitted to Payroll on time for payment.
P-16 Form
Temporary Employment Service Contract |
![]()
|
P-65 Form - Time sheet for Substitute Teaching Service Record & Claim (use if you are a permanent teacher substituting for another teacher or if you are a regular substitute teacher)
P-15 Form - Time Sheet for Substitute/Hourly Employees (Classified substitute and Substitute Teacher with P-16 contract) |
![]()
|
![]()
|
Substitute (non-Permanent) Pay Period Time Sheet Deadline (Pay every 10th of the Month)
PLEASE REFER TO MUSD 20-21 PAYROLL SCHEDULE DEADLINES FOR EXTRA WORK DURING THE MONTHS OF NOVEMBER, DECEMBER AND JANUARY DUE TO THE HOLIDAYS.
Payroll & Benefits Dept Contacts |
Human Relations Dept Contacts |
Tel: 1-408-635-2600 | Fax: 1-408-635-2621
Dept E-mail: Payroll@musd.org Dept general number: x6012 Ria Feldman, x6026, RFeldman@musd.org (Benefits) Sherry Ames, x6027, SAmes@musd.org (Payroll) Uyen Dao, x6021, UDao@musd.org (Time sheets; Mortgage employment verification) Mortgage Loan Application Mortgage employment verification request MUST be sent via fax or e-mail with the employee's authorization page. Such request will be completed within three business days from receipt date. Requests are completed and returned via fax back to the company. Employee's salary information will not be released via phone. |
Human Relations
Tel. 1-408-635-2600 | Fax: 1-408-635-2617 Employment Status Verification, hire date, status, and job title Dept. E-mail (District G-mail user only): HumanResources@musd.org Charlotte Torres, x6075, CTorres@musd.org Virginia Coleman, x6079, VColeman@musd.org Kay Dasu, x6074, KDasu@musd.org Maria Elena Montoya x6076, EMontoya@musd.org Heather Forsyth-Cano, x6073, HForsyth@musd.org Absence Tracking employee access: http://ars.sccoe.org/ |