Union Affiliation: PCTEA











    1. Health Insurance Enrollment Form
      1. Waiver Form if you decline to enroll in District Health Insurance
    2. Group Life Insurance Enrollment Form
    3. Employee Notification Acknowledgement


    Optional Benefits

    • Pre-Tax Retirement Savings - 403(b) and/or 457(b) Deferred Compensation
    • Health and/or Dependent Care Flexible Spending Account
    • Commuter Benefit Account
    • Employee Assistance Program

    Failure to return all required forms, completed in their entirety, will result in a processing delay. 



    Health Insurance



    Health Insurance Eligibility

    There are 2 premium Blue Cross Blue Shield of WNY plans for you to choose from. You may choose to have single or family coverage. View the eligibility guidelines to determine who can be considered a dependent for family coverage.  


    Health Insurance Effective Date

    The effective date of the insurance coincides with your hire date unless you submit your completed enrollment forms more than 30 days post your hire date.  Then, your effective date is the first of the following month.


    Information on how to choose the best plan for your family.


    Traditional Insurance - There is no network to choose from, so this plan provides the flexibility of going to any medical provider.  (It is imperative that I go to Doctor X, no matter what!)

    Plan A may work for an employee/dependent(s) who travels extensively, especially internationally, or for someone/dependent who has a unique medical situation for which they need specialized services and/or equipment.  This plan has a $150 single, $300 family deductible (in addition to bi-weekly payroll contribution), which the employee must meet before insurance kicks in.  Please review the services on pages 3 & 4 of the detailed chart above, as those tend to require a 20% co-insurance of the cost of the service/procedure/equipment.  This means the District pays 80% of the bill, and the employee is responsible for 20% of the bill (out of pocket maximum is $500 single and $1000 family).  


    Point of Service – Enrollees must choose from doctors enrolled in the network, or be required to pay co-insurance for the cost of their service.  (It is not imperative that I go to Doctor X. I can find another highly qualified doctor, in my area, that is enrolled in the BCBS network).

    Plan B may work for an employee/dependent(s) who generally remain in the Western New York region for the majority of their time, and are not experiencing unique medical situations that need specialized services and/or equipment.  This is a generic POS plan, and you have the ability to choose the co-pay amount that best fits your needs, and also helps an employee budget for medical costs for the year (x number of doctor’s visits/year x $15 = out of pocket expenses).  


    The Benefits Office is unable to advise in choosing a health insurance plan. The Patient Protection and Affordable Care Act requires Group Health Plans to provide a Summary of Benefits and Coverage for each available plan. These comprehensive descriptions are designed to provide standardized information for the purpose of comparison.


    To access the summaries for the plans available to you please click here: PCTEA Summary of Benefits and Coverage or contact the Benefits Office at Benefits@buffaloschools.org to request a paper copy.   


    You also have access to a health insurance comparison chart and the complete plans are listed below:


    Plan A Medical Document and Plan A Prescription Document 


    Plan B Medical Document and Plan B Prescription Document 


    To find out if a doctor is in the BCBS of WNY network, visit:



    Access to the Health Insurance Enrollment Form


    2022 - 2023 Health Contributions

    Eligible employees hired on or after December 7, 2011, shall contribute to health insurance at the rate of 20% of the cost of the premium. Employees who opt to enroll in the Traditional Plan will be responsible for contributing the cost difference between the POS 204 and Traditional Plan, in addition to their contribution. All contributions will be taken bi-weekly pre-tax from your paycheck. 


    Plan A - Traditional 

    Coverage         Bi-weekly Contribution
    Single              $170.49
    Family             $221.16

    Plan B - POS 204

    Coverage          Bi-weekly Contribution
    Single              $55.93
    Family             $154.16

    Your application will be processed when your appointment is approved by the Board and all completed paperwork and required documentation is received in the Benefits Office.



    Health Insurance Waiver


    Waiver logo


    If you are receiving health insurance coverage from another source: You are eligible to participate in the Waiver Program, which entitles you to $100 per month in lieu of health insurance. This benefit is time-sensitive and not retroactive.  

    If you are married to a Board of Education Employee you are only eligible for one family policy. The employee not enrolled in health insurance may take advantage of the Waiver Program by completing the form.  The form is listed as 1a at the top of this webpage.




    Group Life Insurance



    Life Insurance is provided at no cost to you.  You are required to have a form on file to identify your beneficiaries. It is also advisable to update this form periodically as you experience life-changing events.  Life insurance is only provided for the employee and ceases upon separation from the District.



    Group Life Insurance Enrollment Form




    Employee Notifications 

    family with stethoscope








    Learn more about your rights to health insurance and benefits, including detailed information on Employee's Responsibility for Health Insurance, Open Enrollment, Summary of Benefits and Coverage, COBRA, HIPAA, the District's Grandfathered Status of the ACA, the Women's Health and Cancer Rights Act, Newborns' and Mothers' Health Protection Act, and Exchange Notice.  Retain this Employee Notification for your records.




    Employee Notification Acknowledgement




    Dental & Vision Benefits


     Dental Vision Logo






    These supplemental benefits are provided by your union. More information is available on the PCTEA website. Contact Ed Klavoon at the PCTEA Union with any questions at:








    Flexible Spending Account (FSA) 




    The Flexible Spending Account program is a benefit that enables you to place pre-tax dollars in an account for unreimbursed healthcare or dependent care expenses. Employees determine the amount to contribute for the year via payroll deductions. 

    • The plan year runs from January 1st through December 31st
    • There are two types of FSA: Medical and Dependent Care
    • Medical FSA - health care expenses that are eligible for reimbursement under the FSA plan include medical, dental, vision, and other expenses not covered under your health insurance (such as co-payments, deductibles, and prescription drugs). 
      • Maximum annual election - $3,050 maximum 
      • Minimum annual election - $200 minimum.
      • Roll-over feature. Up to $610 in unused funds can roll from 2023 plan year to the 2024 plan year. Any excess funds in excess of $610 will be forfeited. Rollover funds will become available on your P&A Card in April even if you do not re-enroll for the next plan year. Separation from service is the only circumstance that would prevent you from utilizing the rollover funds in the future.
      • All eligible expenses must be incurred by December 31st. If you choose to use paper Reimbursement Claim Forms they must be submitted by March 31st. 
    • The IRS no longer allows employees who intend to retire during the middle of a plan year the ability to accelerate payments to the Health FSA to be used at a time after separation from their employer.  Your card will be deactivated upon separation. Should there be unspent funds in the Health FSA when separation from the District occurs prior to the end of the plan year (December 31st), you will be provided with COBRA information.  




    • Dependent Care FSA - expenses that are eligible for reimbursement include such items as childcare and eldercare services.  The Dependent Care FSA can help you pay your eligible out-of-pocket dependent care costs. Expenses are limited to household services or the care of one or more qualifying individuals (i.e., a dependent child less than age 13 or a dependent adult), while you are at work.
      • Maximum annual election - $5,000 (if single or if married and filing jointly)
      • Maximum annual election - $2,500 (if married and filing separately) 
      • Minimum annual election -  $200
      • A grace period of 75 days to incur expenses in the new plan year and have those expenses be paid out of the previous years' contributions.  Unspent funds after the grace period expires are forfeited. 
      • Reimbursement Claim Forms must be submitted by March 31st.  


    Learn more about how a Health Care FSA works.


    P&A Group Flexible Spending Account Brochure



    Initial enrollment must occur within 30 days of hire or during the open enrollment period (November 1st – November 30th).  Employees determine the amount to contribute for the year via payroll deductions. It is called your annual election. For 12-month employees, your annual election will be deducted over 26 pay periods and for 10-month employees, your annual election will be deducted over 19 pay periods. This will be pro-rated for newly hired employees or those who are enrolling due to life-changing events at a time other than the beginning of the calendar year.


    FSA Enrollment Form 






    The commuter benefits plan allows you to set aside money – tax-free – for mass transit and parking expenses associated with your employment.  Participating in the Commuter Benefit Plan will enable you to save taxes on the money you use to pay for work-related mass transit and parking. You may elect to reduce your taxable pay by the amount you expect to pay for parking and or transit. The amount you elect is withheld from your paycheck. Your payroll withholdings are credited to an account that is available to pay the cost of your eligible expenses.  


    Parking (tax shelter the cost of your Parking expenses)

    • Maximum annual election -  $300 per month
    • Minimum annual election -   $10 per pay


    Mass Transit (tax shelter the cost of your Mass Transit expenses)


    • Maximum annual election - $300 per month
    • Minimum annual election -  $10 per pay



    Commuter Benefit Enrollment 






    Tax Shelter Annuities




    ALL EMPLOYEES ARE ELIGIBLE to save for retirement by contributing to a 403(b) Plan and/or a 457 NYS Deferred Compensation Plan, through payroll deductions. There are two major benefits to participation in these tax shelter plans. First, you do not pay income tax on contributions until you begin making withdrawals from the plan, usually, after you retire. Additionally, earnings and gains are not taxed until you make withdrawals.



    The District has contracted with The OMNI Group to administer the 403b Tax Shelter Program. Please visit their website at omni403b.com for further information or to download a Salary Reduction Agreement (SRA) to make changes to your existing account. (Please note that while the OMNI SRA has the availability to list multiple Service Providers, you may only choose ONE (1) provider for your payroll deductions.)  To open a new account, please refer to the list of Participating Service Providers that have been provided below for your convenience.


    For further information on the NYS 457 Deferred Compensation Plan visit their website at https://www.nysdcp.com/iApp/tcm/nysdcp/about/index.jsp or call the helpline at 1-800-422-8463. If you already are enrolled in the Plan and wish to make changes to your bi-weekly contribution please contact NYSDCP.


    Informational video on what is a tax shelter annuity and how to choose the best one for you:



    2023 Maximum Allowable Contribution (MAC) limits

    $22,500 or $30,000 if age 50 or older

    Note: you may contribute to both a 403(b) and a 457 NYS Deferred Compensation Account. 




    Employee Assistance Program 




    The District provides an EAP service that provides free & confidential services to our employees and their family members who may be experiencing personal &/or work-related issues.  Services included:


    • Assessments
    • Short-term Counseling
    • Referrals
    • Follow-up Services


    ComPysch also has incredible resources on its website, that includes articles, slide shows, and training on the following topics:


    Communication Skills

    Personal Development



    Family & Relationships

    Behavioral Health & Wellness

    Older Adult Care

    Legal & Financial


    Access the Employee Assistance Program contact information to learn more.