Benefits
Medical/Rx, Vision, Dental, Flexible Spending & BuyOut / BuyDown
Contact: Karen DelPriorePhone: 315-635-4545 Email: kdelpriore@bville.org
The Benefit's Office is now located in the transportation building at 2810 WestEntry Drive, B'ville.
OPEN ENROLLMENT: The District's Open Enrollment period for medical and dental insurance will beginMonday, August 19, 2024 and continue through Wednesday, September 18, 2024. This is the only time of year that employees are allowed to enroll in new coverage or make changes to their existing coveragewithoutexperiencing a qualifying life event (ex. birth, marriage, loss of coverage).
Open enrollment changes go into effect onSeptember 1, 2024.
This is also the time to:
- Switch between dental plans. For example - Is someone going to need braces this year? Or do I no longer need the orthodontic plan?
- Add children to a dental plan. For example – Have a young one getting ready for their first dental visit?
- Elect or renew your Buy Down or Buy Out elections. These do not automatically carryover from year to year. You must submit paperwork every year.
If you do not need to make changes to your medical or dental coverage, no action is required by you. Send enrollment forms and support documents directly to Karen DelPriore at theBenefits Office. Open Enrollment"Quick Clicks":
Your current coverage will continue into the new benefit year.
PLEASE NOTE: Enrollment forms received by the Benefits Officeby September 6will have deductions begin with the 9/13 payroll.Enrollment forms receivedbetween September 7 through September 18will have deductions begin with the 9/30 payroll (1 payroll later) and will have a one-time adjustment (catch-up) deduction in addition to the regular deduction.
NEW for this year: All CSEA members will have benefit deductions begin with the 9/30/24 payroll and continue for a total of 19 pays, through 6/30/25.
Initial enrollment and/or dependent additions require support documentation to be included with the enrollment forms.
Required documentation includes copies ofsocial security cardsandbirth certificatesforALLenrollees; as well asmarriage licenses, tax returnsandcourt ordersandchild support orders, if appropriate.
Enrollment booklets - with medical, vision and dental plan information:
The deadline to submit forms for open enrollment is September 18, 2024.
MEDICAL INSURANCE INFORMATION:
| MEDICAL PLAN CONTACT INFORMATION | EXCELLUS(Blue Cross Blue Shield) ♦PHONE: Customer Service 1-877-253-4797 ♦ CLAIMS:EXCELLUS, P.O. BOX 21146, EAGAN, MN 55121 ♦WEBSITE & MEMBER PORTAL: Excellus BCBS (You can see all your Excellus plans in one portal) ♦ Create an online member account –Online Member Account Guide ♦ View plan benefits, request ID cards,check claim status, view authorizations, and more Medical Provider Search-Direct linkFind a Doctor.Search the Excellus national Blue Card network to find a participating doctor, hospital, urgent care, etc. The prefix for Classic Blue isVYW. |
| MEDICAL PLAN INFORMATION | The District's medical offeringis the Classic Blue Traditional planthat is administered by Excellus BCBS. Medical Plan Summaries(SBC): International Travel:Coverage available under Blue Cross Blue Shield Global Core (formerly BlueCard Worldwide®)
TELEMEDICINE INFORMATION:Excellus has partnered with MDLIVE for telemedicine services. |
| PRESCRIPTION DRUG INFORMATION: | EXCELLUS Pharmacy Customer Service RETAIL (local in-store) PRESCRIPTIONS Formulary Guide:Use the ExcellusFormulary Guide(drug list) to determine the tier level of your medication. The specific copayments of drug tiers is contractually determined and is available in the Plan SBC's. MAIL ORDER PRESCRIPTIONS: Express Scripts-Member Services: 1-855-315-5220 Wegmans Home Delivery- Member Services: 1-800-586-6910 |
| RATES for MEDICAL PLAN | Medical Insurance Rates for Active Employees : 2024-25 Medical Rateseffective 9/1/2024 through 8/31/2025 |
| MEDICAL PLAN FORMS | Enrollment booklets- for medical, vision and dental plansalong with an enrollment form: BESPA BTA CSEA BAPIS NonAligned BTSSA Public Library Enrollment FormUse this form for initial enrollments and changes to current enrollment. Extra Dependents FormUse this form as an additional page to the enrollment form if you have more than 3 dependents to enroll or update. Updates must be done Privacy Authorization Form-For access to claims of spouse and dependents age18 and older. Additional information is available on the Excellus website - underManage Your Privacy. Claim Form - Medical- Use to manually submit amedical claim. Medicare Eligibility Form-Use to notify of an insured's medicare eligibility for any reason (Age, Disability or ESRD). Copyofmedicare card required. |
| RETIRED MEMBERS | Medical Plan Summaries (SBC): ♦BTA ♦BAPIS ♦CSEA ♦Non Aligned ♦Administrators ♦BTSSA ♦BESPA - Rx $5/20/40 ♦BESPA - Rx $5/10/25 Medicare Eligibility form:Medicare Eligibility Form-Use to notify of an insured's medicare eligibility for any reason (Age, Disability or ESRD). Copyofmedicare card required. AutoPay Authorization form:AutoPay form- To update your banking information used to pay for retiree premiums. |
VISION INSURANCE INFORMATION:
| VISION PLAN INFORMATION | The District's vision benefit is provided by Davis Vison and administered by Excellus as of 9/1/2022. ♦All medical plan participants are automatically enrolled in the Davis Vision plan. ♦Members receive a separate identification card from Excellus/Davis Vision. ♦Vision ID cards will only display the name of the subscriber (dependents are not named on the card). ♦ Benefit provides coverage for routine eye exams and eyeglasses or contacts. Vision Plan Description:Davis Vision Summary |
| VISION PLAN CONTACT INFORMATION | DAVIS VISION ♦PHONE: Davis VisionCustomer Service - 1-888-921-1194 ♦ CLAIMS: Vision Care Unit, PO Box 1525, Latham, NY 12110. ♦MEMBER PORTAL:Excellus BCBS Login & Select 'Simply Vision Gold' from the 'Multiple Polices' drop down at top center of the page. Next, click the secure link to the Davis Vison portal (blue button on the bottom right) to view benefit information, print ID cards, find participating providers, and more. |
| VISION PLAN FORMS | ♦Davis Vision Claim Form Claim Form for direct reimbursem*nt; for visits to an out-of-network provider.NOTE: You must a 'Davis Vision' claim form, not an 'Excellus' Vision claim form to submit a manual claim. |
DENTAL INSURANCE INFORMATION:
| DENTAL FORMS | Enrollment Form - Excellus Dental- For dental enrollments. Extra Dependents FormUse this form if you have more than 3 dependents to enroll or update. Claim Form - Excellus Dental- Use to manually submit a dental claims. Privacy Authorization Form- For access to claims of spouse and dependents age 18 and older. |
| DENTAL CONTACT INFORMATION | EXCELLUS BLUE CROSS BLUE SHIELD as of 9/1/2020 ♦PHONE: Excellus Dental Customer Service -1-800-724-1675 ♦ CLAIMS:Excellus Dental Claims, P.O. Box 21146, Eagan, MN 55121 ♦WEBSITE & MEMBER PORTAL:Excellus BCBS Create an online member account -Online Member Account Guide View plan benefits, request ID cards,check claim status, view authorizations, and more |
DENTAL PLAN INFORMATION | Plan Summaries: ♦Plan 1- Excellus Premium plan ♦Plan 2- Excellus Orthodontic plan ♦Dental ID cards will only display the name of the subscriber (dependents are not named on the card). |
| Plan Descriptions: ♦Plan 1- Premium plan (100/100/80% and $2,000 calendar year maximum) Noorthodontics. ♦Plan 2- Orthodontic plan (100/80/60/50% and $1,250 calendar year maximum; $1,500 lifetime ortho maximum) | |
| Dental Provider Search- Direct linkFind a Doctor -The provider networks includeDental Blue OptionsandNational Dental GRID+ DenteMaxeffective 9/1/22. | |
| STUDENT CERTIFICATION | Student Certification:- Unmarried dependents between the ages of 19 and 25 are eligible for dental coverageonly ifthey are certified as full time students. Student Certification Form- Form required by Excellus to certify students. Must be mailed directly to Excellus. |
| RATES for DENTALPLAN | Dental Insurance Ratesfor active employees:2024-25 Dental Dductionseffective 9/1/2024 through 8/31/2025 |
FLEXIBLE SPENDING ACCOUNT (FSA) INFORMATION:
| Flexible Spending Accounts (FSA) FSA is a calendar year benefit (January through December) and deductions are withheld over 20 pay periods. Open enrollment for FSA is in Novemberfor an effective date of January 1. You may elect one or both of the following: ♦Health Care Account(HCA) for out-of-pocket medical expenses such as copays, prescription drugs, orthodontics, vision care, hearing aids, dental services and eligible over-the-counter (OTC) items, and more. |
| FSA CONTACT INFORMATION | LIFETIME BENEFIT SOLUTIONS ♦ WEBSITE / PORTAL:Lifetime Benefit Solutions -Quickly determine FSA eligible products - with and without a doctor's prescription. |
| FSA CLAIMS | Reimbursem*nt Methods: ♦FSA Health Spending Visa Card-Use card to directly debit from your account. No claim forms needed, but all receipts must be maintained and are subject to verification. ♦FSA Website-Submit form & receipts on line. ♦Fax-Submit form & receipts by faxat1-877-256-7228. ♦ Mail - Submit form & receipts by mail to: Lifetime Benefit Solutions, FSA Claims Dept, P.O. BOX 211126, Eagan, MN 55121 ♦FSA Claiming Terms & Conditions Reimbursem*nt Forms: ♦Medical Reimbursem*nt Form ♦Dependent CareReimbursem*nt Form |
FSA FORMS | Enrollment Kit-For Flexible Spending Accounts (FSA) in calendar year2024 Enrollment Form Only- For enrollment in 2024 medical reimbursem*ntand/or dependent care accounts. Medical Necessity Form-Some services and products are only eligible for reimbursem*nt when certified medically necessary by a doctor or other provider. Privacy Authorization Form- Use to allow access toaccount informationto aspouse, etc. |
| BUY OUT BUY DOWN ELECTION FORMS | Buy Out / Buy Down elections This documentation must be submitted For the 2024-25 school year, the deadline is September 18, 2024. Submit the following to the Human Resources Office for approval:
Payment of the election amount will be divided over 20 pay periods (or 19 pays for CSEA members) to align with the benefit deductions schedule. Payments are subject to FICA, federal and state income taxes. A Buy Out / Buy Down election applies to medical insurance only. An employee may enroll in dental coverage with the District and still receive the Buy Out. |
