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.

Medical and Prescription Drug Plan Changes – July 1, 2019

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

Customer Service Team 2019

Panel of Physicians

Highmark Enrollment Form 2021

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

2022 Annual Notices and Disclosures

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 7-1-2021

Vision Insurance Benefits Summary 7-1-2020

Vision Insurance Professional Staff Payroll Deduction Form 2021-22

Vision Insurance Support Staff Payroll Deduction Form 2021-22

Contact Lens Information

LASIK Information

 

QHDHP Summary of Benefits–Coverage 2021-22

PPO Plan G Summary of Benefits–Coverage 2021-22

PPO Plan E Summary of Benefits–Coverages 2021-22

PPO Plan C Summary of Benefits-Coverage 2021-22

PPO Bronze Summary of Benefits–Coverage 2021-22

Health Care Preventative Health Care Schedule

Medicare Creditable Coverage Notice 2021

2022 Annual Notices and Disclosures

Highmark How to Register on Your Member Website Flyer

Highmark Virtual ID Card

Highmark Virtual Care

AMWell – Allows you to talk to a Doctor from Home

Express Scripts – Mobile App

S3 Generic Prescription Drugs

Medical and Prescription Drug Plan

Notice Regarding Wellness Program 2019-20

Wellness Program

NTIC Health and Wellness Program Guide 2019-2020

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)