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 Summary 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 to: kathy.vanschaick@ntiogasd.org or kim.fish@ntiogasd.org to request a copy of the Summary Plan Description or any of the attachments.
Plan Document and Summary Plan Description
PPO Bronze Benefit Booklet 2021
The link below is published in accordance with the Consolidated Appropriations Act (CAA) Transparency in Coverage Rule, requiring publication of machine-readable files. The files are being hosted by our medical benefit administrator, and can be accessed at the link included below.
Highmark groups: mrfdata.hmhs.com
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.
Notice – Advanced Imaging Services Need Prior Authorization
Flex 125 Information:
Dental Benefits Information:
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Dental Benefits Enrollment form
Delta Dental Non-Discrimination Disclosure
Delta Dental Gramm-Leach-Bliley Financial Privacy Notice
Delta Dental HIPPA Notice of Privacy Practices
Life Insurance Benefits Information:
PT Support Staff Employees who work 9 months per year Basic Life 7-1-2021
FT Support Staff Employees who work 9 months per year Basic Life 7-1-2021
FT Support Staff Employees who work 12 months per year Basic Life 7-1-2021
Professional Employees Basic Life 7-1-2021
Administrative Employees Basic Life 7-1-2021
Life Insurance Enrollment or Beneficiary Change Form 2018
Life Insurance Conversion Notice Form (002)
Privacy Notice for Life Insurance
Voluntary Vision Insurance Information
NVA Vision Benefit Summary 2024-2028
Annual Notices & Health Care Resources:
Outline of Coverages QHDHP 7-1-2025
Outline of Coverages PPOE 7-1-2025
Outline of Coverages PPO Bronze 7-1-2025
Outline of Coverages PPO Blue Plan G 7-1-2025
Outline of Coverages PPO Blue Plan C 7-1-2025
Summary of Benefits and Coverage QHDHP 7-1-25
Summary of Benefits and Coverage PPO G 7-1-25
Summary of Benefits and Coverage PPO E 7-1-25
Summary of Benefits and Coverage PPO C 7-1-25
Summary of Benefits and Coverage PPO Bronze 7-1-25
Northern Tioga SD – 2024 Medicare Creditable Coverage Notice_N033
2025 Annual Notices and Disclosures
Highmark How to Register on Your Member Website Flyer
Well360_Virtual Health BCBS_FS 12-2023
Wellness Program
NOTICE REGARDING WELLNESS PROGRAM
NTIC Annual Physical Examination Verification Form
NTIC Annual Vision Examination Verification Form
NTIC Cervical Cancer Screening Verification Form
NTIC Colonoscopy Examination Verification Form
NTIC Dental Examination Verification Form
NTIC Dermatology Examination Verification Form
NTIC Health Screening Consult Verification Form
NTIC Mammogram Screening Verification Form
NTIC Primary Care Provider Verification Form
NTIC Prostate Screening Verification Form
Employee Assistance Program (EAP)
https://www.theeap.com/video-library/educators-employee-orientation
EAP Employee Summary
EAP FAQ
Wellness Coaching
Legal Resources
Financial Coaching
ESI-Coaching-Flyer
Counseling Help From Your EAP