Health Insurance

Group Health Insurance Election/Waiver 2023

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 full-time employees of eligible churches working 30+ 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 full-time Pastors and employees of eligible churches, working 30+/hours/week on a full time basis with the option of spousal and dependent coverage to age 26.
- Our Church waives the 2023 group health insurance plan
- Our Church will participate in the 2023 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

2023 Group Health Insurance (3 Options)

Independent Health iDirect Silver Coinsurance HSAQ

Employee $492.17
Employee and Children $836.69
Employee & Spouse $984.34
Family $1402.68
Deductibles:
- Individual – $3000
- Family – $6000
HSA Qualified
iDirect Silver Coinsurance HSAQ_pdf

Independent Health iDirect Silver Copay HSAQ

Employee $525.39
Employee and Children $893.16
Employee & Spouse $1050.78
Family $1497.36
Deductibles:
- Individual – $2000
- Family – $4000
HSA Qualified
iDirect Silver Copay HSAQ_pdf

Independent Health Standard Silver (Non-HSA Qualified)

Employee $545.14
Employee and Children $926.74
Employee & Spouse $1090.28
Family $1553.65
Deductibles:
- Individual – $1750
- Family – $3500
Not Eligible for Health Savings Account
Standard Silver SNF 365_pdf

Pediatric Dental

$15.43/child/month
Dependents under the age of 19 are automatically enrolled (unless waived)

Enrollment – December 21 Deadline

2023 Enrollment Waiver Form– New or Re-enrolling with no changes to dependent status or address

Enrollment/Change Form – First time enrolling or changes of dependent status, phone, or mailing address

Health Savings Account Overview 2023

2023 IH Medical Plan Packet

WNY District of the Wesleyan Churches Compliance Notices 2023

Please send enrollment forms by mail, email or fax to:

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

Email: office@wnydistrict.com

Fax: 716-648-4053