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.
Families First Coronavirus Response Act:
Medical and Prescription Drug Plan Changes – July 1, 2019
Plan Document and Summary Plan Description
PPO Bronze Benefit Booklet 2018
2019 Preventive Health Schedule
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:
Professional Staff Health Insurance Information:
Health Insurance Enrollment Form 2016
Professional Staff Insurance Opt Out Form
Support Staff Health Insurance Information:
Health Insurance Enrollment Form 2016
Act 93 Support Staff Insurance Opt Out Form
Act 93 Staff Health Insurance Information:
Health Insurance Enrollment Form 2016
Act 93 Support Staff Insurance Opt Out Form
Dental Benefits Information:
Dental_Benefits – Effective July 1, 2018
Dental Benefits Enrollment form
Life Insurance Benefits Information:
Support Staff 12 months 7-1-19
Support Staff 9 month Employee 7-1-19
Life Insurance Enrollment or Beneficiary Change Form 2018
Privacy Notice for Life Insurance
Voluntary Vision Insurance Information:
Vision Insurance Benefits Information
Vision Insurance Enrollment Form
Vision Insurance Professional Payroll Deduction Authorization 2018-2019
Vision Insurance Support Payroll Deduction Authorization 2018-2019
Annual Notices & Health Care Resources:
Annual Insurance Updates – PPO or Traditional
Annual Notice PPO Option C – Outline of Coverages 2019-2020
Annual Notice PPO Option E – Outline of Coverages 2019-2020
Annual Notice PPO Option G – Outline of Coverages 2019-2020
Annual Notice PPO Option Bronze – Outline of Coverages 2019-2020
PPO E Summary of Benefits and Coverage 2019-2020
PPO C Summary of Benefits and Coverage 2019-2020
Health Care Preventative Health Care Schedule
Medicare Part D Creditable Coverage Notice 2018
2012 Women’s Health and Cancer Rights Act notice
Highmark How to Register on Your Member Website Flyer
AMWell – Allows you to talk to a Doctor from Home
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