2019 Benefits - Elected Officials Elected Hired
on or Before 8/17/15
Health Insurance
Classic Blue Excellus BCBS Summary Document
Rates - Individual Per Pay Period $ 93.63
- Family Per Pay Period $202.94
Rx Co-Pay - $5/$20/$35, 2x @ Mail
Blue PPO Excellus BCBS Summary Document
Rates - Individual Per Pay Period $ 92.14
- Family Per Pay Period $199.49
Rx Co-Pay - $5/$20/$35, 2x @ Mail
Platinum Plan Excellus BCBS Summary Document
Rates - Individual Per Pay Period $ 62.97
- Family Per Pay Period $163.72
Rx co-pay: $5/$35/$70, 2x @ Mail
Health Insurance Enrollment Form and Dependent Eligibility Verification
Dental Insurance
Excellus BCBS Dental Blue Options - Low Option Summary Document - 2019 Rates: $31.86/Month Individual; $83.67/Month Family (100% Employee Paid)
Excellus BCBS Dental Blue Options - High Option w. Ortho Summary Document - 2019 Rates: $39.87/Month Individual; $104.70/Month Family (100% Employee Paid)
Excellus BCBS Dental Blue Options Enrollment Form
Vision Insurance - 2019 Rate: $24.34 Per Month
Platinum Vision Summary Document
Platinum Vision Enrollment Form
Flexible Spending Account