Health Insurance 2022-23

Enrollment/Change Form
Waiver of Coverage Form
Annual Dependent Verification
Teachers Out-of-Pocket Cost Estimator

Rates

100%
CSEA 20 Pay
GTA 20 Pay Prior to October, 1 2022
GTA 20 Pay After October, 1 2022
CSEA 24 Pay

Plan Descriptions

BP2 $5/$10 Copay ($0/$30/$50)
BP2 $5/$10 Copay ($5/$15/$30)
BP2 $15 ($0/$30/$50)
BP2 $15 ($5/$20/$35)
BP2 $20 ($0/$30/$50)
BP2 $20 ($5/$20/$35)
HealthyBlue $15
HealthyBlue $25
HealthyBlue $30
HDHP $1500 w prev rx
HDHP Preventive Rx List

Plan Comparisons

Healthy Blue $15 - $25 - $30
Healthy Blue $25 - BP2 $20 ($5/$20/$35) - HDHP $1500 w/ prev rx
BP2 $5/$10 ($0/$30/$50) - BP2 $15 ($0/$30/$50) - BP2 $20 ($0/$30/$50)
BP2 $5/$10 ($5/$15/$30) - BP2 $15 ($5/$20/$35) - BP2 $20 ($5/$20/$35)

Benefit Resources (BRI)- Pretax Benefit Accounts

Health Savings Account (HSA)

Used to pay for out-of-pocket medical expenses if on a High Deductible Health Plan. Only need to complete from if new enrollment or making a change.

HSA Enrollment/Change Form
HSA Brochure
Why Do I Need An HSA

Flexible Savings Account (FSA)

Used to pay for health related expenses (Medical FSA or Limited Purpose FSA) and/or Dependent Care FSA. Must complete form yearly if you would like to remain enrolled.

FSA Enrollment/Change Form
FSA Brochure
Why Do I Need A Medical FSA
Why Do I Need a Dependent Care FSA
Why Do I Need a Limited FSA

BRI Direct Deposit Form

Supplemental Insurance

Employee Benefit Fund (formally Solstice Dental & Vision)

10 Month EBF Member Plus Dental and Vision Rates
12 Month EBF Member Plus Dental and Vision Rates
EBF Member Plus Enrollment Form
Member Plus Dental Plan Booklet
Dental Provider Listing
Member Plus Vision Plan Booklet
Vision Provider Listing

Aflac (dental, cancer, accident, life, disability)

Aflac Open Enrollment Flyer

Required Notices

Annual Required Compliance Notices
Cobra Notification