BUFFALO

This health insurance plan is available to all Medicare-eligible retirees & their eligible dependents (who are enrolled in Medicare Part A and Part B).  Retirees who are eligible for district health insurance are encouraged to review the chart below to determine their eligibility for enrollment in this health insurance plan.

The Passport PPO program includes several benefits. The chart below describes the benefits for those subscribers who live in the 8 counties of Western New York.  For those who live outside of the area, your information is here.

Passport PPO includes additional benefits that you will find valuable, including: 

• Lab Services – Participation with all local labs, not just Quest Diagnostics.

• Prescription Coverage – Tier enhancements to many commonly-used prescriptions, including vaccines, along with less requirements for prior authorization or step therapy.

• Senior Savings Program – Get a $30 incentive reward just for doing your free Enhanced Annual Wellness Visit with your doctor.

• Receive a $10 reward for completing a Health Risk Assessment

• 3 Local Member Service Centers – Conveniently located and staffed with experienced RedShirts 5 days a week, year-round, to answer your questions and help you get the most from your health plan and your health care dollar.

Please call Member Services with medical or pharmacy benefit questions, or if you are in need of care management services or help in locating a provider, etc. 

Independent Health Member Services

Phone: 716-250-4401

Toll-Free: 1-800-665-1502

(TTY: 711)

Enrollment 

Retirees can choose to enroll in the Independent Health Passport PPO by completing the Medicare Advantage Form.  Applications will be accepted any month during the year once a retiree has reached Medicare eligibility and is enrolled in Part A & Part B.  Applications received by the 15th of the month, will be processed for the first day of the next month.  Applications received by the Benefits office will be processed for the first day of the following month.

For example, applications received by June 15th will be processed for July 1st; applications received after June 15th will be processed for August 1st.  

Should a retiree, or their eligible spouse/dependent, choose to return to a commercial benefit plan, they must take action during annual Open Enrollment, which is held in the month of November, and identify a plan that was available to them at the time of the retirement.   

Please send the completed form to the BCSD Benefits Office by scanning or taking a picture via email: Benefits@buffaloschools.org

OR

Fax (716) 816-3587 

• Enrollment Application Passport PPO

• Benefit Summary In Area

• Benefit Summary Out of Area

• 2024 Medicare Star Ratings

• Care Management and Continuity Request Form

• $0 Copay for Select Part D Prescription Drugs

• Dental Reimbursement Form

• Vision Out of Network Claim Form

• ProAct Pharmacy Services Form

• Provider Wallet Card (print and take with you when traveling outside of Western New York)

• Wegmans Mail Order Pharmacy Form