Group Health Insurance Election/Waiver 2026

As determined by the Standing Rules of the Western New York District of the Wesleyan Church, eligible churches have the option to participate in the WNY district group health insurance plan for eligible employees. As an eligible church under the WNY District plan, each church must either waive or elect to have their church participate in the plan. The confirmation or waiver must be communicated to the WNY District Office, in writing, one month prior to the plan year. Participation in the plan is open to all employees of eligible churches working 20+ hours per week on a full time basis. Spousal and dependent coverage to age 26 is also available. Additional eligibility or ineligibility (specific to a special class of employees and/or contractual terms) may also pertain to specific churches. If a church chooses to participate, it must either offer the plan to all eligible employees or determine its own specific policy regarding which classes of employees are eligible. This policy should be decided by the board and recorded in the board minutes and must be in compliance with all applicable health care and labor laws.

Your Name*
First Last
Your Email*

A confirmation of this form will be sent to this email address
Church Name*
Your Position at the Church:*
I understand that the WNY District health insurance plan is open to Pastors and employees of eligible churches, working 20+/hours/week with the option of spousal and dependent coverage to age 26.
- Our Church WAIVES the 2026 group health insurance plan
- Our Church WILL PARTICIPATE in the 2026 group health insurance plan
Per church policy, our church offers the district group health insurance to the following classes of employees:*
- All full-time employees
- Only full-time pastoral staff
- Only Senior Pastor
If there are any Pastors or full-time employees who are lawfully excluded from coverage, please explain below.
Today's Date
MM slash DD slash YYYY
Digital Signature*
- I hereby submit this form as the authorized representative of the church

2026 Group Health Insurance (4 Options)

Independent Health iDirect Bronze Coinsurance HSAQ

Employee $691.14
Employee and Children $1174.94
Employee & Spouse $1382.28
Family $1969.75
Deductibles:
- Individual – $6000
- Family – $12000

Independent Health iDirect Silver Coinsurance HSAQ

Health Savings Account Qualified
Employee $762.06
Employee and Children $1295.50
Employee & Spouse $1524.12
Family $2171.87
Deductibles:
- Individual – $3500
- Family – $7000

Independent Health iDirect Silver Copay HSAQ

Health Savings Account Qualified
Employee $815.26
Employee and Children $1385.94
Employee & Spouse $1630.52
Family $2323.49
Deductibles:
- Individual – $2250
- Family – $4500

Independent Health Silver Copay (Option 2) (Non-HSA Qualified)

NOT Eligible for Health Savings Account
Employee $841.55
Employee and Children $1430.64
Employee & Spouse $1683.10
Family $2398.42
Deductibles:
- Individual – $2500
- Family – $5000

Overview of Plans

Plans Overview 2026

Pediatric Dental

Pediatric Dental Details
$15.44/monthly premium
Dependents under the age of 19 are automatically enrolled (unless waived)

Enrollment Forms – December 15, 2026 Deadline

Contact the office if you are enrolling for the first time. Please send enrollment forms by mail or email to:

Mail: Western New York District of The Wesleyan Church
4669 Pinecrest Terrace
Eden, NY 14057