Union Affiliation: Local 264 Cook Manager









    1. Health Insurance Survey
    2. Health Insurance Enrollment Form
      1. Waiver Form if you decline to enroll in District Health Insurance
    3. Dental Insurance Enrollment Form
      1. Dental Waiver Form if you decline to enroll in District Dental Insurance
    4. Group Life Insurance Enrollment Form
    5. 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.


    Enhanced Insurance (Traditional) - 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).  


    Base Insurance (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: LOCAL 264 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:



    2022 - 2023 Health Contributions

    Eligible employees hired on or after 7/1/14 shall contribute to health insurance at the rate of 20% of the cost of the premium for the Base Plan. Employees who opt to enroll in the Enhanced Plan will be responsible for contributing 20% of the Base Plan plus the difference in premium between the Base and Enhanced Plans. All contributions will be taken pre-tax over the course of 20 pay periods.


    Plan A - Enhanced Plan 

    Coverage         Bi-weekly Contribution
    Single              $196.82
    Family             $272.99

    Plan B - Base Plan

    Coverage          Bi-weekly Contribution
    Single              $72.71
    Family             $200.40

    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 

    Canva LI


    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 Insurance


    Dental Vision Logo







    Dental Insurance is offered through Emblem (formerly known as GHI) at the annual cost of $150.48 which is deducted from the employee's bi-weekly pay pre-tax.  Please access the GHI Emblem Dental Summary for more information. 


    Employees that do not want to accept the District's dental insurance will receive an annual amount of $300 ($25 per month of enrollment).  Complete and submit the Dental Waiver Form (listed as 3a at the top of this webpage).  This benefit is time sensitive and is not retroactive.


    If you have a full-time dependent student who is at least 19 years of age, unmarried, and receives at least half of his/her support from the employee/member, and is enrolled full-time in an accredited secondary or preparatory school or college, then you must complete the Student Verification Form.






    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, 2022
    • 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 - $2,850 maximum 
      • Minimum annual election - $200 minimum.
      • $570 Roll-over feature. Up to $570 in unused funds can roll from one plan year to the next. Any excess funds in excess of $570 will be lost. Rollover funds will become available on your P&A Card in April even if you do not re-enroll for 2021. 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 




    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:



    2022 Maximum Allowable Contribution (MAC) limits

    $20,500 or $27,000 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.