Office of Human Resources
(315) 792-3276
Employee Benefits
Benefit Information
Health Insurance – Excellus BCBS
- Rates
- Enrollment Form
- Summary Plan Description
- Option 1: Healthy Blue with HSA & Healthy Rewards
- Option 2: Simply Blue – without HSA funding
- Option 3: Blue PPO - For Medicare Eligible Only
- Health Insurance Waivers
Website: www.excellusbcbs.com
Phone Number: 1-800-499-1275
Prescription Coverage - OptumRX
- OptumRX Overview
- Transition Guide
- Premium Standard Formulary
- Preventative Drug List (coming soon!)
Website: www.OptumRx.com
Phone Number: 1-855-265-0191
Dental Insurance – Guardian Dental
Website: www.guardianlife.com
Phone Number: 1-800-541-7846
Vision Insurance – Davis Vision
Website: www.davisvision.com
Phone Number: 1-800-999-5431
Flexible Spending Account (FSA) – Lifetime Benefit Solutions
- Flexible Spending Highlights
- Enrollment Form
- Dependent Care Reimbursement Request Form
- FSA Reimbursement Form
Website: www.lifetimebenefitsolutions.com
Phone Number: 1-800-327-7130
TIAA Retirement
Website: TIAA.org/Utica
Phone Number: 800-842-2252
Representative:
Mark Couch, TIAA Financial Consultant
Phone: (866) 698-4221
Email: mcouch@tiaa.org
Employee Assistance Program (EAP) – NextGen
Website: www.nexgeneap.com (Company ID: 9000)
Phone Number: 1-800-EAP-CALL
Voluntary Insurance
- UNUM Term Life Highlights & Rates
- UNUM Enrollment Form
- Prudential AD&D Highlights & Rates
- Prudential Enrollment Form
UNUM Website: www.UNUM.com
UNUM Phone Number: 1-800-275-8686
Prudential Website: www.prudential.com
Prudential Phone Number: 1-877-232-3619
Miscellaneous
Previous Benefit Year Information
Section 1: Health Insurance
- 2021 Health Insurance Rates
- 2021 Health Insurance Enrollment Instructions
- 2021 Health Insurance Wavier Buyout
- 2021 HealthyBlue General Plan Summary
- 2021 HealthyBlue Forms
- 2021 Health Savings Account Contributions
- 2021 Health Savings Account (HSA) Contribution Schedule
- 2021 Health Savings Account (HSA) Salary Reduction Form (Qualifying Expenses are listed in Section 4, first bullet)
- 2021 BluePPO General Plan Summary
- 2021 Simply Blue General Plan Summary
- 2021 Preventive RX Drug List
- 2021 Preventative RX Explanation
- 2021 Health Exchange Notice
- Rally Health Rewards Instructions
- 2021 SimplyBlue Enrollment Form
- 2021 Welfare Benefits SPD
Please visit the Excellus BCBS website at www.ExcellusBCBS.com
Section 2: Dental Insurance
- 2021 Dental Insurance Coverage Overview
- 2021 Dental Insurance Enrollment Kit
- 2021 Dental Insurance Rate Information
- Guardian Maximum Rollover (High Plan only)
Please note: If you are not making changes to your current dental coverage, you do not need to complete new forms.
Section 3: Vision Insurance
Visit Davis Vision at www.DavisVision.com
Section 4: Flexible Spending Account (F.S.A.)
- 2021 Flexible Spending Enrollment Information
- 2021 Flexible Spending Qualifying Expense List
- 2021 Flexible Spending Enrollment Form
- 2021 Dependent Care Enrollment Form
- 2021 Flexible Spending Reimbursement Form
Section 5: TIAA
- TIAA Online Enrollment Instructions for New Employees
- TIAA Online Account Management
- TIAA Live Date Nov. 9, 2020
- TIAA Information for Adjuncts
- TIAA Defined Contribution Summary Plan Description
- TIAA Tax Deferred Annuity Summary Plan Description
Section 6: Tuition Benefits
Section 7: Voluntary Insurance
- Life AD&D LTD Highlight Sheet
- UNUM Term Life Highlight Sheet
- UNUM Term Life Enrollment Form
- Beneficiary Form
- Prudential Additional AD&D Rates
- Prudential Enrollment Form
Section 8: Miscellaneous
- Lifelock Identity Theft Protection
- BJs Wholesale Club Memberships
- Verizon Wireless Discounts
- Enterprise Car Rental
Section 9: Health and Wellness Resources
- May - Mental Health Resources / Excellus BCBS:
- March - National Nutrition / Excellus BCBS Videos:
- Bored Stressed Hungry (video)
- 10-Day Challenge
- Healthy Eating Booklet
Click here for a snapshot of the 2020 Benefits offerings
Section 1: Health Insurance
- 2020 Health Insurance Rate Information
- 2020 Health Insurance Enrollment Instructions
- 2020 Health Insurance Wavier Buyout Memo
- 2020 Health Insurance Wavier Buyout Form & Memo
- 2020 SBC Blue PPO Copay Plan
- 2020 PPO Summary of Benefits and Coverage
- 2020 SBC HealthyBlue $1800 with Healthy Rewards and HSA Funding
- 2020 HealthyBlue Summary of Benefits and Coverage
- 2020 HealthyBlue Enrollment Form
- 2020 Health Savings Account Contributions
- 2020 Health Savings Account (HSA) Contribution Schedule
- 2020 Health Savings Account (HSA) Salary Reduction Form (Qualifying Expenses are listed in Section 4, first bullet)
- 2020 Preventive RX Drug List
- Rally Health Rewards Instructions
- 2020 SBC SimplyBlue $1800 with no HSA Funding
- 2020 SimplyBlue (Low Cost Plan) Summary of Benefits and Coverage
- 2020 SimplyBlue Enrollment Form
Please visit the Excellus BCBS website at www.ExcellusBCBS.com
Section 2: Dental Insurance
Please visit Delta Dental at www.DeltaDentalIns.com
Section 3: Vision Insurance
Visit Davis Vision at www.DavisVision.com
Section 4: Flexible Spending Account (F.S.A.)
- 2020 Flexible Spending Enrollment Information
- 2020 Flexible Spending Qualifying Expense List
- 2020 Flexible Spending Enrollment Form
- 2020 FSA/LPFSA/HRA Medical Claim Reimbursement Form w/Instructions
Section 5: TIAA
- TIAA Online Enrollment Instructions
- TIAA for Adjuncts
- 2020 Salary Reduction Form
- Defined Contribution Summary Plan Description
- Tax Deferred Annuity Summary Plan Description
Section 6: Voluntary Insurance
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