2022 Group Health Insurance (3 Options)

Independent Health iDirect Silver Coinsurance HSAQ

• Employee $428.07
• Employee and Children $727.72
• Employee & Spouse $856.14
• Family $1220.00
•  Deductibles:
  • Individual – $3000
  • Family – $6000
• HSA Qualified
• Benefit Summary – iDirect Silver Coinsurance HSAQ 2022

Independent Health iDirect Silver Copay HSAQ

• Employee $458.32
• Employee and Children $779.14
• Employee & Spouse $916.64
• Family $1306.21
• Deductibles:
  • Individual – $2000
  • Family – $4000
• HSA Qualified
• Benefit Summary – iDirect Silver Copay HSAQ 2022

Independent Health Standard Silver (Non-HSA Qualified)

• Employee $493.53
• Employee and Children $839.00
• Employee & Spouse $987.06
• Family $1405.56
• Deductibles:
  • Individual – $1300
  • Family – $2600
• Not Eligible for Health Savings Account
• Benefit Summary – Standard Silver 2022

Pediatric Dental

• $15.43/child/month
• Dependents under the age of 19 are automatically enrolled (unless waived)
• 2022 IH Pediatric Dental Group Packet

Enrollment – December 15 Deadline

Church Election/Waiver Form

2022 Enrollment Waiver Form – 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 Info for 2022

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