Employees may choose to enroll in any combination of the benefits listed below.
Excellus Blue Cross & Blue Shield - Liverpool offers employees a comprehensive medical and prescription drug plan through Excellus Blue Cross Blue Shield. Open enrollment is December with the effective coverage date of January 1. The health plan consists of four parts:
- Blue Cross covers Hospitalization
- Blue Shield covers Medical/Surgical Benefit
- Major Medical covers Enhanced Medical Benefits
- Prescription Drugs
Please notify Tracy Sheridan of any changes listed below by calling 315-622-7978 or e-mailing her at email@example.com:
- Change of coverage (for example individual to family or vice versa)
- Name or address changes
- Add a new spouse within 30 days of the date of marriage (a copy of the marriage license is required)
- Add a new baby within 30 days of the baby's birth (a copy of the birth certificate is required)
- Excellus Enrollment Form
- Excellus Shared Information Authorization
- Excellus Prescription Claim Form
- Excellus Claim Form
Guardian - Guardian is the dental plan offered to Liverpool employees. Summary Plan documents are available by calling the Human Resources office at 315-622-7978. Claim forms are available in each building, on the Guardian website or below.
- Guardian Plan Information Booklet
- Guardian Enrollment Form
- Guardian Claim Form
- Dental Dependent Eligibility Certification Form
Flexible Spending Account
Preferred Group Plans, Inc. - Use the Preferred Group Plans, Inc. website to find out how you can save 30% to 40% by using pre-tax dollars to pay for out-of-pocket dependent day care, medical, dental and vision expenses and insurance premiums. Enrollment is during the month of December for the next calendar year.
Flex Plan forms:
- Flex Plan Change in Status
- Flex Plan Reimbursement Voucher
- Flex Plan Termination from Service
- Flex Plan Q & A Brochure
- Flex Plan Over the Counter Products Guidelines
- Flex Plan Claim Submission Guidelines
The Omni Group - A supplemental retirement plan which provides an opportunity to save money from your paycheck on a pre-tax basis while allowing your money to grow tax-deferred until retirement.
403(b) Universal Availability Notice - You have the opportunity to save for retirement by participating in Liverpool Central School District's 403(b) retirement plan. If there are any questions, you may contact the Plan's administrator, The OMNI Group at 877-544-6664. Please click on the link below for details.
Direct Deposit (call Terri Wills 315-622-7105 with questions)
You may have your paycheck sent to as many as three different financial institutions but, only one account each. Fill out the Direct Deposit Authorization form and submit it to Human Resources.
|Excellus Enrollment Form||210 KB|
|Excellus Prescription Claim Form||75 KB|
|Excellus Claim Form||117 KB|
|Excellus Shared Information Authorization||383 KB|
|Flex Plan Change in Status Form||25 KB|
|Flex Plan Reimbursement Voucher||343 KB|
|Flex Plan Termination of Service Form||92 KB|
|Flex Plan Claim Submission Guidelines||252 KB|
|Flex Plan Over the Counter Products Guidelines||70 KB|
|Flex Plan Q & A Brochure||2.2 MB|
|Guardian Dental Claim Form||12 KB|
|Guardian Enrollment Form||281 KB|
|Guardian Plan Information Booklet||286 KB|
|Omni Salary Reduction Agreement Form||490 KB|
|403(b) Universal Availability Notice||30 KB|
|Dental Dependent Eligibility Certification Form||29 KB|