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Health Insurance
Forms
Use to waive coverage
Use for any enrollment in medical or dental plans
Open Enrollment Rates 25-26
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.pdf25 26 MTA HC rates hired after June 30 2005
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.pdf25 26 CSEA HC rates hired after July 1 2004
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.pdf25 26 Superintendent HC rates
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.pdf25 26 Non Union HC rates Full Time
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.pdf25 26 MTA HC rates hired prior to June 30 2005
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.pdf25 26 CSEA HC rates hired prior to July 1 2004
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.pdfMAA HC rates hired before July 1 2021
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.pdfMAA HC rates hired after July 1 2021
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.pdf25 26 Asst Supt HC rates
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.pdf25 26 School Business Administrator HC rates
Retiree Plan Information 2025
- HMO Information: $15 & $20
- PPO Information:$15& $20
- 2024 Excellus Medicare HMO & PPO Application
- Medicare Supp Application
- 2024 Simply P 5 20 35 3x Rx
- 2024 Simply P Application
- Medicare 2024 rates
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.pdfSimply P Rx Application
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.pdfMarion CSD 2025 Excellus ER MBC HMO $20 co pay 10 30 50 3x Rx Dental
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.pdfMarion CSD 2025 Excellus Group MAPD Application
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.pdfMarion CSD 2025 Excellus ER MBC HMO $15 co pay 5 20 35 3x Rx Dental
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.pdfMarion CSD 2025 Excellus ER MB PPO $15 co pay 5 20 35 3x Rx Dental
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.pdfMarion CSD 2025 Excellus ER MB PPO $20 co pay 10 30 50 3x Rx Dental
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.pdfMarion CSD 2025 Simply P 5 20 35 3x Rx
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.pdfExcellus FitON Flyer
