Medical & Dental Benefits 

For plan pricing please contact Robin Genetti 851-1172

Medical  (click here for helpful definitions)

• BCBS Plan Brochure
• Premium Grid FY19
• BCBS Enrollment & Change Form
• BCBS Health Insurance Waiver
• BCBS Summary of Benefits and Coverage including HRA (Printed copies available at no cost from HR)
  • VEHI Platinum
  • VEHI Gold
  • VEHI Gold CDHP
  • VEHI Silver CDHP
• Telemedicine with Amwell - medical help via computer, tablet or smartphone
  • Link to website and app download instructions
• Medicare, Prescriptions and Creditable Coverage Notice

• Link to VEHI's page and plan details (including video series)

Dental

• Dental Enrollment Form
• Dental Plan Policy Summary
• Dental Plan Policy (complete)
• Dental Waiver of Coverage

FSA, HRA and Dependent Care Claim Forms with DataPath

• FSA Claim Form
• HRA Claim Form
• Dependent Care Claim Form
• Mysource debit card replacement or additional card request form

Family Medical Leave 

• FMLA - Family Medical Leave Act
• Request for Leave Form
• Return to Work Form

Quick Links

• Open Enrollment
• Medical & Dental Benefits
• Employee Assistance
• Retirement Plans
• Life Insurance and Long Term Disability
• Forms
• Discount Programs