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    Insurance and Benefit Information

    Welcome to the Insurance & Benefits Information Section of the District Website

    The information found here includes the most recent Summary Plan Description with additional links to dental and flexible spending account plan benefits that are listed as attachments in the Summay Plan Description.  This version has been updated from any previous document delivered to you. 

    You have a right to request and obtain a paper version of the documents at no charge.  Contact the Business Manager at 814-258-5644 X1022 or email wanda.erb@ntiogasd.org or kim.fish@ntiogasd.org to request a copy of the Summary Plan Description or any of the attachments.

     

    Medical & Prescription Drug Plan Changes - July 1, 2016

    Northern Tioga School District Insurance Summary Plan Description

    Flex 125 Plan Information

    Flex 125 Card Information

    Flex 125 Enrollment Form

    Professional Staff Insurance Opt Out Election Form

    Professional Staff Health Insurance Election Form

    Act 93 Administrator & School Psychologist Health Insurance Election Form

    Act 93 Support Staff Health Insurance Election Form

    Support Staff (6 or More Hours per Day) Health Insurance Election Form

    Support Staff (Less Than 6 Hours per Day) Health Insurance Election Form

    Support Staff Insurance Opt Out Election Form

    Health Insurance Enrollment Form

    Privacy Notice for Life Insurance and Disability Insurance

     

    Medical Insurance Questions

    If you have questions regarding your medical insurance coverage or an insurance claim, our representative at the Henry Dunn Agency may be able to assist you.  Click here for more information.

     

    Dental Benefits Plan Document

    Dental Enrollment Form

    Information Regarding United Concordia

    Professional and Administrative Staff Dental Benefits

    Support Staff Dental Benefits

     

    Life Insurance Benefits Plan Documents

    Professional Staff Life Insurance Benefits

    Support Staff (9 months) Life Insurance Benefits

    Support Staff (12 months) Life Insurance Benefits

    Life Insurance Enrollment or Beneficiary Change Form

     

    Voluntary Vision Insurance (2017/18 Rates Not Available Yet)

    Vision Insurance Benefits Information

    Vision Insurance Enrollment Form

    2016-17 Professional Payroll Deduction Form

    Contact Lens Information

    LASIK Information

     

    Annual Notices & Health Care Resource

    Annual Insurance Updates - PPO or Traditional

    Annual Notice - PPO Option C - Summary of Benefits & Coverage
    Annual Notice - PPO Option C - Outline of Coverages

    Annual Notice - PPO Option E - Summary of Benefits & Coverage
    Annual Notice - PPO Option E - Outline of Coverages

    Annual Notice - PPO Option G - Summary of Benefits & Coverage

    Annual Notice - Traditional - Summary of Benefits & Coverage
    Annual Notice - Traditional - Outline of Coverages

    Annual Notice - PPO Bronze - Summary of Benefits & Coverage
    Annual Notice - PPO Bronze - Outline of Coverages

    Glossary of Health Coverage & Medical Terms

    Blue Cross Preventative Schedule
    Blue Cross Preventative Schedule Addendum

    Notice - Advanced Imaging Requires Authorization

    Medicare Part D Creditable Coverage Notice

    Women's Health and Cancer Rights Act Notice

    CHIP Model Notice

    BC - Your Service Book

    BC - Your Wellness Book

    BC - Mobile App

    Express Script - Mobile App

    Tier 0 Prescription Program