Baldwinsville Central School District

Benefits

Medical/Rx, Vision, Dental, Flexible Spending & BuyOut / BuyDown
Contact: Karen DelPriore Phone: 315-635-4545 Email: kdelpriore@bville.org

The Benefits Office is located in the transportation facility at 2810 West Entry Drive, B'ville.

OPEN ENROLLMENT

MEDICAL/VISION and DENTAL INSURANCE:

The District's Open Enrollment period for medical/vision and dental insurance begins on Monday, August 17, 2026 and continues through Wednesday, September 16, 2026.

This is the only time of year that employees are allowed to enroll in new coverage or make changes to their existing coverage without experiencing a qualifying life event.

Open enrollment changes go into effect September 1, 2026.

Quick Links: Enrollment form 26.27 Payroll Deductions

If you do not need to make changes to your medical or dental coverage, no action is required by you. Your current coverage will continue into the new benefit year.

NOTE: If the only change is to make is to switch between dental plans (making no dependent changes), you do not need to re-submit support documents;

just a completed enrollment form (including the dependent information) is required.

The deadline to submit forms and support documentation for open enrollment is September 16, 2026.

Submit forms and support documentation to Karen DelPriore in the Benefits Office which is located at the transportation facility at 2810 West Entry Rd.

Paperwork can be submitted in person, via interoffice mail or email.

BUY OUT / BUY DOWN ELECTIONS:

Quick Link: Buy Out Elections

The deadline to submit the annual buyout election documents is September 16, 2026.

Submit forms and support documentation to Karen DelPriore in the Benefits Office.

Paperwork can be submitted in person, via interoffice mail or email.

FLEXIBLE SPENDING ACCOUNTS (FSA):

There will be a separate open enrollment period for the 2027 Flexible Spending Accounts (FSA) for unreimbursed medical expenses and dependent care.

More information regarding this calendar year benefit will be released in early November 2026.

MEDICAL INSURANCE INFORMATION:

MEDICAL PLAN CONTACT INFORMATION	EXCELLUS (Blue Cross Blue Shield) ♦ PHONE: Customer Service 1-877-253-4797 ♦ CLAIMS: EXCELLUS, P.O. BOX 21146, EAGAN, MN 55121 ♦ WEBSITE & MEMBER PORTAL: Excellus BCBS (You can see all your Excellus plans in one portal) ♦ Create an online member account – Online Member Account Guide ♦ View plan benefits, request ID cards, check claim status, view authorizations, and more Medical Provider Search - Direct link Find a Doctor. Search the Excellus national Blue Card network to find a participating doctor, hospital, urgent care, etc. The prefix for Classic Blue is VYW.
MEDICAL PLAN INFORMATION	The District's medical offering is the Classic Blue Traditional plan that is administered by Excellus BCBS. ♦ as offered through the Cooperative Health Insurance Fund. ♦ Calendar year deductible is $50 per individual with a $150 family maximum. ♦ After deductible, the annual co-insurance maximum is $400 per individual with a $1,200 family maximum. ♦ Prescription drugs are subject to a separate co-payment schedule and out-of-pocket maximum. ♦ Medical ID cards are issued all enrolled members, with each dependents' name listed on the front. Dental and vision ID cards with only list the name of the subscriber. Medical Plan Summaries (SBC): ♦ BTA ♦ BESPA ♦ CSEA ♦ Non Aligned ♦ BAPIS ♦ BTSSA ♦ Public Library Wellness: Blue365 is an online destination where members can find deals and exclusive discounts on health-related products and services including Tivity Health’s Fitness Your Way gym membership program. It is free to join, all you need is your Excellus medical member ID card to get started. ♦ Visit the website at Blue365Deals Travel with Confidence: Blue Card – coverage is available nationwide. Review the Blue Card brochure for more information. Global Core – International coverage is available. Refer to the Global Core brochure for details. Visit the Global website at BlueCross BlueShield Global Core Call the Service Center at 1.800.810.2583 Telemedicine Information: Excellus has partnered with MDLIVE for telemedicine services. FLYER - What is Telemedicine? FLYER - TeleHealth vs. TeleMedicine GUIDE - TeleMed Frequently Asked Questions YOUTUBE - How to Register for MDLIVE® YOUTUBE - How to Use MDLIVE®
PRESCRIPTION DRUG INFORMATION:	EXCELLUS Pharmacy Customer Service ♦ PHONE: 1-877-253-4797 ♦ Enrollment in pharmacy benefit is concurrent with medical plan participation. RETAIL (local in-store) PRESCRIPTIONS ♦ Use your Excellus Member ID card for prescription purchases. ♦ Prescription purchases at a local retail pharmacy are limited to a 30 day supply. ♦ To manually submit a pharmacy claim, complete and submit the Pharmacy Claim Form. Formulary Guide: Use the Excellus Formulary Guide (drug list) to determine the tier level of your medication. The specific copayments of drug tiers is contractually determined and is available in the Plan SBC's. MAIL ORDER PRESCRIPTIONS: ♦ Maintenance prescriptions (90 day supply) are only available by mail order. ♦ Initial fills of new prescriptions are limited to a 30 day supply. Express Scripts - Member Services: 1-855-315-5220 Set up a Mail Order Account at www.Express-Scripts.com ExpressScripts Info Sheet Express Scripts Forms: Rx Mail Order form Wegmans Home Delivery - Member Services: 1-800-586-6910 Set up a Home Delivery Account Wegmans Home Delivery Info Sheet Wegmans Home Delivery Form: Wegmans Home Delivery form
RATES for MEDICAL PLAN	Rates for Medical Insurance: 2026-27 Medical Rates effective 9/1/2026 through 8/31/2027.
MEDICAL PLAN FORMS	Enrollment Form – Use for initial enrollments and changes to current enrollment. Enrollment booklets - for medical, vision and dental plans along with an enrollment form: pending Updates must be done within 30 days of date of eligibility or status change (birth, divorce, medicare eligibility, loss of coverage, etc.). Support documentation must be included with enrollment forms. Required documents include copies of birth certificates and social security cards for all enrollees; as well as marriage licenses, financial proof (tax return), court orders and child support orders, if appropriate. HIPAA – Sharing Protected Health Information: Link to the Excellus Privacy Authorization Form which is required to authorize access to the health information, including claims, of your insured dependents. Additional information is available on the Excellus website - under Manage Your Privacy. Claim Form - Medical - Use to manually submit a medical claim. Medicare Eligibility Form - Use to notify of an insured's medicare eligibility for any reason (Age, Disability or End Stage Renal Disease). Copy of medicare card is required.
RETIRED MEMBERS	Medical Plan Summaries (SBC): ♦ BTA ♦ BAPIS ♦ CSEA ♦ Non Aligned ♦ BTSSA ♦ BESPA Medicare Eligibility form: Medicare Eligibility Form - Use to notify of an insured's medicare eligibility for any reason (Age, Disability or ESRD). Copy of medicare card is required. AutoPay Authorization form: AutoPay form - To update your banking information used to pay for retiree premiums.

VISION INSURANCE INFORMATION:

VISION PLAN INFORMATION

The District's vision benefit is provided by Davis Vison and administered by Excellus as of 9/1/2022.
♦ All medical plan participants are automatically enrolled in the Davis Vision plan.
♦ Members receive a separate identification card from Excellus/Davis Vision.
♦ Vision ID cards will only display the name of the subscriber (dependents are not named on the card).
♦ Benefit provides coverage for routine eye exams and eyeglasses or contacts.

Vision Plan Description: Davis Vision Summary

VISION PLAN

CONTACT INFORMATION

DAVIS VISION
♦ PHONE: Davis Vision Customer Service - 1-888-921-1194
♦ CLAIMS: Vision Care Unit, PO Box 1525, Latham, NY 12110.
♦ MEMBER PORTAL: Excellus BCBS Login & Select 'Simply Vision Gold' from the 'Multiple Polices' drop down at top center of the page. Next, click the secure link to the Davis Vison portal (blue button on the bottom right) to view benefit information, print ID cards, find participating providers, and more.

VISION PLAN FORMS

♦ Davis Vision Claim Form Claim Form for direct reimbursement; for visits to an out-of-network provider.

NOTE: You must a 'Davis Vision' claim form, not an 'Excellus' Vision claim form to submit a manual claim.

DENTAL INSURANCE INFORMATION:

DENTAL FORMS	Enrollment Form - Excellus Dental - For dental enrollments. Claim Form - Excellus Dental - Use to manually submit a dental claims. Privacy Authorization Form - For access to claims of spouse and dependents age 18 and older.
DENTAL CONTACT INFORMATION	EXCELLUS Blue Cross Blue Shield as of 9/1/2020 ♦ PHONE: Excellus Dental Customer Service - 1-800-724-1675 ♦ CLAIMS: Excellus Dental Claims, P.O. Box 21146, Eagan, MN 55121 ♦ WEBSITE & MEMBER PORTAL: Excellus BCBS Create an online member account - Online Member Account Guide View plan benefits, request ID cards, check claim status, view authorizations, and more.
DENTAL PLAN INFORMATION	Plan Summaries: ♦ Plan 1 - Excellus Premium plan ♦ Plan 2 - Excellus Orthodontic plan ♦ Dental ID cards will only display the name of the subscriber (dependents are not named on the card).
	Plan Descriptions: ♦ Plan 1 - Premium plan (100/100/80% and $2,000 calendar year maximum) No orthodontics. ♦ Plan 2 - Orthodontic plan (100/80/60/50% and $1,250 calendar year maximum; $1,500 lifetime ortho maximum)
	Dental Provider Search - Direct link Find a Doctor - The provider networks include Dental Blue Options and National Dental GRID+ DenteMax effective 9/1/22.
STUDENT CERTIFICATION	Student Certification: Unmarried dependents between the ages of 19 and 25 are eligible for dental coverage only if they are certified as full time students. Student Certification Form - Form required by Excellus to certify students. Must be mailed directly to Excellus.
RATES for DENTAL PLAN	RATES for Dental Insurance: 2026-27 Dental Deductions effective 9/1/2026 through 8/31/2027.

FLEXIBLE SPENDING ACCOUNT (FSA) INFORMATION:

FLEXIBLE SPENDING ACCOUNT INFORMATION	Flexible Spending Accounts (FSA) FSA is a calendar year benefit (January through December) and deductions are withheld over 20 pay periods. Open enrollment for FSA is in November for an effective date of January 1. You may elect one or both of the following: ♦ Health Care Account (HCA) for out-of-pocket medical expenses such as copays, prescription drugs, orthodontics, vision care, hearing aids, dental services and eligible over-the-counter (OTC) items, and more. ♦ Dependent Care Account (DCA) for care expenses for dependent children under age 13 (daycare, preschool, summer camps) who are claimed on your federal tax return or a disabled spouse or other dependent on your tax return who resides with you and is physically or mentally disabled. ♦ Website Portal Instructions ♦ FSA Summary Plan Description
FSA CONTACT INFORMATION	LIFETIME BENEFIT SOLUTIONS ♦ PHONE: Customer Service 1-800-327-7130 ♦ WEBSITE / PORTAL: Lifetime Benefit Solutions - Create an online account to view your account summary, track contributions and payment status ♦ FSA Store - Use your flexible spending account and discover surprisingly FSA eligible products - Quickly determine FSA eligible products - with and without a doctor's prescription.
FSA CLAIMS	Reimbursement Methods: ♦ FSA Health Spending Visa Card - Use card to directly debit from your account. No claim forms needed, but all receipts must be maintained and are subject to verification. ♦ FSA Website - Submit form & receipts on line. ♦ Fax - Submit form & receipts by fax at 1-877-256-7228. ♦ Mail - Submit form & receipts by mail to: Lifetime Benefit Solutions, FSA Claims Dept, P.O. BOX 211126, Eagan, MN 55121 ♦ FSA Claiming Terms & Conditions Reimbursement Forms: ♦ Medical Reimbursement Form ♦ Dependent Care Reimbursement Form
FSA FORMS	Enrollment Kit - For Flexible Spending Accounts (FSA) in calendar year 2026 Medical Necessity Form - Some services and products are only eligible for reimbursement when certified medically necessary by a doctor or other provider. Privacy Authorization Form - Use to allow access to account information to a spouse, etc.
BUY OUT BUY DOWN ELECTION FORMS	Buy Out / Buy Down Elections An employee is eligible for the Health Insurance Buy Out / Buy Down program on an annual basis with the submission of a completed election form, benefit verification form and satisfactory evidence that the employee (and dependents, if applicable) has alternative health insurance coverage (typically through a spouse or parent). This documentation must be submitted each school year by the close of the District’s open enrollment period. For the 2026-27 school year, the deadline is September 16, 2026. NEW: There are no longer separate forms for each bargaining unit, just one consolidated form. The Buy Out / Buy Down packet includes both forms. Submit the following to the Human Resources Office for approval: Buy Out / Buy Down Election Form Benefit Verification Form 'Proof of Other Coverage' - Acceptable forms of proof of other coverage include a letter or written statement from the other health insurance carrier or employer dated within the last sixty days, or a dated screenshot from an insurance portal, etc. Insurance ID cards alone are not sufficient proof. Any proof must list our employee and all insured dependents in order to qualify for a family Buy Out / Buy Down election. Payment of the election amount will be divided over 20 pay periods (or 19 pays for CSEA members) to align with the benefit deductions schedule. Payments are subject to FICA, federal and state income taxes.

1095-C Statement

1095-C form Important Notice: 1095-C Statement Available Upon Request (Calendar Year 2025)

A 1095-C is a form employers use to report information about the health insurance they offered to employees. It’s part of the Affordable Care Act (ACA) requirements.

1095-C forms help employees when filing their taxes, as they indicate whether the employer offered them health coverage that meets ACA standards. The form is not required to prepare or submit your 2025 taxes.

The Paperwork Burden Reduction Act (H.R. 3797), passed recently, now provides some flexibility in terms of providing a copy of the applicable 1095 forms to employees.

Current employees may access your 1095-C in WinCapWeb or if you are not a current employee you may request a copy of your 1095-C form, please contact Karen DelPriore at kdelpriore@bville.org.

1095-B Forms are issued and mailed by Excellus. For more information regarding 1095-B please go to the Excellus BCBS website.