Buffalo City School District Employee Health Insurance Enrollment Form Page 9
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15For questions specific to coverage contact: Blue Cross @ 887-8880 or 1-888-299-2263
Plan C - Plan of benefits
Plan B - Plan of benefits
Plan D - BC/BS POS
CATEGORY
Plan A - BC/BS Traditional
formerly offered through
formerly offered through IHA
Community Blue
Univera
*Except where otherwise stated,
BCBSWNY has a calendar year
deductible of $150 per
individual ($300 per family).
Where the deductible applies,
and when it has been met, Major
Major Medical
Not applicable.
Not applicable.
Not applicable.
Medical pays 80% of the
Schedule of Allowances until
benefits total $2,000 per
individual, ($4,000 per family)
then pays 100% of the Schedule
of Allowances for that year.
Unlimited lifetime max.
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