THERE ARE FIVE (5) REQUIRED FORMS THAT YOU MUST COMPLETE AND SUBMIT TO THE BENEFITS OFFICE WITHIN 30 DAYS OF HIRE TO ESTABLISH YOUR BENEFITS.  

INSTRUCTIONS ON HOW TO COMPLETE AND SUBMIT ELECTRONIC FORMS HERE 

1. Health Insurance Survey

2. Health Insurance Enrollment Form OR

   2 A. Waiver Form if you decline to enroll in District Health Insurance

3. Dental Insurance Enrollment Form OR

   3 A. 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 Eligibility

There are 2 premium Highmark 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.

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 Highmark 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 via email 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 

Please be advised that once a plan is chosen, it cannot be changed until our open enrollment period in November of each year.

To find out if a doctor is in the Highmark of WNY network, visit the WNY Network website.

2024 - 25 Health Contributions
Eligible employees hired on or after 7/1/12 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 the payrolls in the fiscal year.

Plan A - Enhanced Plan 

Plan B - Base Plan

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.

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.  You must complete the form to receive the waiver.

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 1 A. at the top of this webpage.

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

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 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 3 A. at the top of this webpage).  This benefit is time sensitive and is not retroactive. You must complete the form to receive the waiver.

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.

For more information and the enrollment forms on both Medical and Dependent Spending Accounts, please click below

For more information on Tax-Shelter Annuity Accounts and how to enroll, please click below

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. 

For more information regarding our EAP, please click below

In June 2017, the Buffalo Board of Education approved the District Wellness Policy.  The District recognizes that in order to achieve student wellness, well-being and academic success employee wellness must also be stressed, emphasizing the importance of creating a District-wide workplace culture that supports employee health and wellness.