Employee Benefits

The ICSD offers employees comprehensive medical plans through Excellus BlueCross BlueShield.

Classic Blue Benefit Grids
Enrollment Application with Addendum
HIPAA Authorization Form
Instructions to Submit HIPAA Authorization Online
Prescription Drug Claim Form
Telemedicine Services FAQs
Telemedicine Services - BCBS

The ICSD offers employees dental and vision plans, administered by Ameritas. The FUSION plan combines dental and eye care benefits in one easy-to-administer plan.

Dental Benefits Handout
Vision Benefits Handout
Eye Care Highlight Sheet
FUSION Highlight Sheet
Dental & Vision Transition Information
Vision Enrollment/Change/Waiver Form
Dental Enrollment/Change/Waiver Form

Dental Claim Form
Vision/Fusion Claim Form

Once you've been enrolled in the Ameritas group plan, you'll receive a certificate outlining your benefits. Contact Ameritas if you haven't received a certificate. You can also access benefit information online by signing into your member account. Upon request, Ameritas will provide members with a paper copy of their certificate.

English Version
Spanish Version

 

The ICSD partners with Pro-Flex Administrators LLC to offer employees Flexible Spending Accounts (FSA). This benefit allows employees to pay for everyday health care, dependent care expenses, and certain individual premium expenses with pre-tax dollars.

Direct Deposit Agreement
Direct Deposit Enrollment Form
Eligible Expenses List
FAQ - FSA with Rollover
FSA Enrollment Form
Mobile App Information
Website & Mobile App Access Info

Forms/Information

Forms/Information