Machine -Readable Files as required by the Transparency in Coverage Rule
Current Insurance Carriers:
Health Insurance: Independence Blue Cross
Health Savings Account
Prescription Drug: Futurescripts
Healthy Lifestyles
Dental:
Vision:
Pennsylvania Insurance Exchange (Pennie)
Change in Insurance Coverage:
It is your responsibility to notify Human Resources if you have a life event that will alter your health insurance coverage. Examples are: marriage, divorce, birth or adoption of a child, child reaching age 19, or change in your spouse's employment resulting in the gain or loss or health care coverage. Our current coverages are: Single, Husband & Wife, Parent & Child, Parent & Children, Family.
Voluntary Waiver of Employee Insurance (Opt-Out):
Employees may waive District paid medical coverage: hospitalization/medical/surgical coverage and/or prescription drug and/or dental.
Waiving coverage is effective at the first of the month following the date the waiver is received in the Office of Human Resources. Revoking a waiver cannot occur until July 1 following the open enrollment period, or some other date if the employee experiences a life event.
Health, Prescription, and Dental Coverage Waiver:
Opt Out Form
OneAmerica® Employee Benefits:
Employees are eligible to receive and/or buy short and long term disability coverage. Please consult your bargaining unit agreement for specific details.
The following forms are available for printing:
Short Term Disability:
403B Annuity Information
Please return completed forms to Sharon Russell in Human Resources.
