2021 Group Health Insurance (3 Options)

Independent Health iDirect Silver Coinsurance HSAQ

• Employee $435.69
• Employee and Children $740.67
• Employee & Spouse $871.38
• Family $1241.72
•  Deductibles:
  • Individual – $3000
  • Family – $6000
• HSA Qualified
• 2021 Summary of Benefits – iDirect Silver Coinsurance HSAQ

Independent Health iDirect Silver Copay HSAQ

• Employee $459.05
• Employee and Children $780.39
• Employee & Spouse $918.10
• Family $1308.29
• Deductibles:
  • Individual – $2250
  • Family – $4500
• HSA Qualified
• 2021 Summary of Benefits – iDirect Silver Coinsurance HSAQ

Independent Health Standard Silver (Non-HSA Qualified)

• Employee $493.04
• Employee and Children $838.17
• Employee & Spouse $986.08
• Family $1405.16
• Deductibles:
  • Individual – $1300
  • Family – $2600
• Not Eligible for Health Savings Account
• 2021 Summary of Benefits – Standard Silver 365 SNF

Pediatric Dental

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

Enrollment – December 15 Deadline

Church Election/Waiver Form

Employee Enrollment Form (Re-enrolling with no changes to dependent status or address)

Employee Enrollment/Change Form – First time enrolling or changes of dependent status or address

For the Full Benefits Booklet – Contact the District Office 716-646-0282

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