Scotia-Glenville Central School District
Scotia, New York
April 20, 2023
To: All Staff
From: Andrew Giaquinto, School Business Manager
RE: OPEN ENROLLMENT
PLEASE NOTE THE FOLLOWING IMPORTANT CHANGES TO THE OPEN ENROLLMENT PROCESS FOR MAY 1, 2023 -MAY 19, 2023
- Enrollment information and materials will be available on the Staff Resources section of our website. Enrollment forms will be attached with instructions as well as Summary Plan documents.
- The enrollment form can be completed and signed electronically. You may scan or send photos of supporting documents (marriage, birth certificates, domestic partner verification documents). We will accept a printed paper enrollment form and supporting documents.
Plan Booklets, SBCs, Summary Plan documents, Insurance Rates, and FLEX enrollment information are on our website: https://www.scotiaglenvilleschools.org/staff-resources/open-enrollment-information-and forms/
- Health and Dental Benefits: If you are making changes to your coverage, AMSURE has developed the attached “fillable” version of the CASHIC enrollment form. Please com lete the form by typing in the necessary content directly on to the form. A typed signature on the signature line of the enrollment form will be accepted as long as you email your enrollment form to our office with the affirmation below in the body of your e-mail.
Please copy/paste the below into your email:
AFFIRMATION I agree, and it is my intent, to sign this application for health insurance by attaching the completed application to this e-mail and by electronically submitting this e-mail to: MMoran@sgcsd.net I understand that my completing the application attached to this e-mail and submitting this e-mail in this fashion is the legal equivalent of having placed my handwritten signature on the attached application and this affirmation. I understand and agree that by electronically signing and submitting this e-mail and attached completed application in this fashion I am affirming to the truth of the information contained therein.
- OPT-OUT FORM: This must be completed each year if you are not enrolling in Health and Dental Benefits through the District. Please provide proof of insurance elsewhere. Please complete the form by typing in the necessary content directly on to the form using the “fill & sign” feature from the menu on the right.
- FLEX enrollment for Dependent Care and Medical Reimbursement: Participation in the portion
of the IRS.125 plan which relates to dependent care and medical expenses that are not covered by insurance must be completed annually, even if you are making no change. Ten-month employees will have twenty (20) deductions while twelve-month employees will have twenty-four (24) deductions. Our plan year is from July 1, 2023 through June 30, 2024. If you have questions regarding allowable expenses or
calculations, please email Martha Moran at mmoran@sgcsd.net. Please note that the maximum. Please note that the maximum amount for medical reimbursement is increasing to $3,050.00. Dependent Care will remain at $5,000.00. Please complete the form by typing in the necessary content directly on to the form using the “fill & sign” feature from the menu on the right
- CanaRx:An option is available on a voluntary basis to active employees and retirees with any of the Blue Shield plans for a cost saving, international mail order drug program for certain brand name prescriptions administered by CanaRx. CanaRx allows an individual to receive at a O (zero) co-pay for any prescriptions offered by them. This is a voluntary program and does not replace your current prescription benefit plan. For further information on this mail order drug program, please go to the District’s website – ScotiaGlenvilleSchools.org, under “Staff Only”, Open Enrollment Information/Forms.
We will accept printed paper enrollment forms and supporting documents.
If you are making changes, please submit as indicated above by May 19, 2023 to allow enough time to process for the June 2, 2023 payroll.
If you have been thinking of making any change to your provider or family status, this period in May is the only time in which you are allowed to make these changes without benefit of a qualifying event. Due to Federal mandates for the Affordable Care Act, the District is required to file reports with the Federal government and its third party administrator. In order to be in compliance with these mandates, the District is asking any employee applying for benefits during this open enrollment period to ensure all forms are completely filled out, including all subscriber and dependent social security numbers.
Thank you for your flexibility during these unprecedented times. Please contact me should you have any questions.
Stay well!