There are four (4) Highmark of Western New York health insurance plans available during Open Enrollment.

Please note that the Benefits Department cannot recommend or advise you on which plan to select. To help determine which plan best meets your needs, you may:

Review plan information on the Local 409 Benefits Page
Contact Highmark and speak with a designated BBOE representative.

Open Enrollment Options

There are five (5) Open Enrollment options available. Select the option that best matches your enrollment needs.

IMPORTANT: Complete only one Open Enrollment form. Submitting multiple forms may delay processing or result in your elections not being processed correctly.

Option #1: Change Your Health Insurance Plan

Choose this option if you would like to change from your current health insurance plan to another available plan.

Complete:
I am only changing my health insurance plan

You will need:

Employee ID Number
Highmark Member ID Card

Option #2: Add or Remove a Dependent

Choose this option if you want to add or remove dependent(s) from your current health insurance coverage and are not changing plans.

Complete:
I am adding/removing a dependent to my health insurance BUT remaining in the same plan

You will need:

Employee ID Number
Social Security Number (SSN)
Date of Birth (DOB)

Required Documentation

Documentation verifying dependent eligibility must be attached.
Examples include:
- Birth certificate
- Marriage certificate
- Other documentation establishing eligibility

Applications submitted without the required documentation will be declined.

Additional Reminder

Consider reviewing and updating your life insurance beneficiary designation.

Option #3: Change Your Plan and Add or Remove Dependent(s)

Choose this option if you need to change your health insurance plan and add or remove dependent(s) at the same time.

Complete:
I am adding/removing a dependent to my health insurance and changing my insurance plan

You will need:

Employee ID Number
Social Security Number (SSN)
Date of Birth (DOB)

Required Documentation

Documentation verifying dependent eligibility must be attached.
Examples include:
- Birth certificate
- Marriage certificate
- Other documentation establishing eligibility

Applications submitted without the required documentation will be declined.

Additional Reminder

Consider reviewing and updating your life insurance beneficiary designation.

Option #4: Health Insurance Waiver Program

Choose this option if you have health insurance coverage through another source and wish to waive District health insurance coverage.

Complete:
Health Insurance Waiver Program – I am receiving health insurance coverage from another source

Important Information

Waiver payments are issued according to the District's waiver program guidelines.
If you are already enrolled in the Waiver Program, you do not need to re-enroll during Open Enrollment.
You will remain enrolled in the Waiver Program until:
- You elect District group health insurance coverage, or
- You separate employment from Buffalo Public Schools.

Option #5: Enroll in Health Insurance

Choose this option if you are not currently enrolled in District health insurance and would like to enroll in coverage

Complete:
I am not currently enrolled in health insurance and would like to enroll

You will need:

Employee ID Number
Social Security Number (SSN)
Date of Birth (DOB)

Required Documentation

Documentation verifying dependent eligibility is required when enrolling in family coverage.
Examples include:
- Birth certificate
- Marriage certificate
- Other documentation establishing eligibility

Applications submitted without the required documentation will be declined.

Before enrolling, review the available plans on the Local 409 Benefits Page.

Life-Changing Events

Certain qualifying life events allow you to make changes to your benefits outside of the Open Enrollment period.

Examples include:

Marriage
Divorce
Birth of a child
Adoption
Death of a dependent
A child obtaining their own health insurance coverage

For additional information, visit the Life-Changing Events Page.

A completed benefits packet and supporting documentation must be submitted to the Benefits Office within 30 days of the qualifying event.

Health Insurance Contribution Rates

Employees hired after February 1, 2007 contribute 15% of the health insurance premium cost.

Payroll Deductions

Contributions are based on the coverage level selected (single or family).
Contributions are deducted on a pre-tax basis through payroll.
Premium contributions are spread over twelve (12) months of payroll deductions.

Employees are encouraged to review all plan materials and cost information on the Local 409 Benefits Page before making their Open Enrollment election.

BUFFALO

Local 409 Open Enrollment

HEALTH INSURANCE • FLEXIBLE SPENDING

Open Enrollment:

1. Health Insurance/Waiver

2. Flexible Spending Account