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

QHDHP Benefit Booklet 2021

PPO G Benefit Booklet 2021

PPO E Benefit Booklet 2021

PPO C Benefit Booklet 2021

PPO Bronze Benefit Booklet 2021

Panel of Physicians

Highmark Enrollment Form 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:

Dental_Benefits – Effective July 1, 2018

Dental Benefits Enrollment form

Delta Dental – Stay Connected

Dental Dental Where’s My ID Card

Delta Dental Non-Discrimination Disclosure

Delta Dental Gramm-Leach-Bliley Financial Privacy Notice

Delta Dental HIPPA Notice of Privacy Pratices

Life Insurance Benefits Information:

Support Staff 12 months 7-1-19

Support Staff 9 month Employee 7-1-19

Professional Staff 7-1-19

Life Insurance Enrollment or Beneficiary Change Form 2018

Privacy Notice for Life Insurance

 

Voluntary Vision Insurance Information

Vision Insurance Benefits Summary 7-1-2023

Contact Lens Information

LASIK Information

 

Medicare Creditable Coverage Notice

Annual Notices and Disclosures 2024

Highmark How to Register on Your Member Website Flyer

Highmark Virtual ID Card

Well360_Virtual Health BCBS_FS 12-2023

Express Scripts – Mobile App

S3 Generic Prescription Drugs

Medical and Prescription Drug Plan

Notice Regarding Wellness Program 2019-20

Wellness Program

2023-2024 Health Advocate Program Guide Updated 8-2023

NTIC Wellness Program FAQ 23-24

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

Flu Shot Verification Form

Employee Assistance Program (EAP)