Confidential, Management, and Elected Officials

Classic Blue Excellus BCBS Summary Document(PDF, 1MB)

• Rates
  • Individual Per Pay Period $287.97
  • Family Per Pay Period $479.14
• Rx Co-Pay - $5/$20/$35, 2x @ Mail

Blue PPO Excellus BCBS Summary Document(PDF, 221KB).

• Rates
  • Individual Per Pay Period $278.05
  • Family Per Pay Period $456.18
• Rx Co-Pay - $5/$20/$35, 2x @ Mail

Platinum Plan Excellus BCBS Summary Document(PDF, 221KB)

• Rates
  • Individual Per Pay Period $ 83.84
  • Family Per Pay Period $217.99
• Rx co-pay: $5/$35/$70, 2x @ Mail

Health Insurance Enrollment Form and Dependent Eligibility Verification(PDF, 1007KB)

• Dutchess Dental Summary Document(PDF, 191KB) - 2024 Rate: $167.00/Month (100% Employee Paid)
• Excellus BCBS Dental Blue Options(PDF, 96KB) - Low Option Summary Document - 2024 Rates: $36.67/Month Individual; $96.35/Month Family (100% Employee Paid)
• Excellus BCBS Dental Blue Options(PDF, 97KB) - High Option w. Ortho Summary Document - 2024 Rates: $45.77/Month Individual; $120.26/Month Family (100% Employee Paid)
• Dutchess Dental/Platinum Vision Enrollment Form(PDF, 176KB)
• Excellus BCBS Dental Blue Options Enrollment Form(PDF, 479KB)

2024 Rate: $24.34 Per Month (100% Employee Paid)

• Platinum Vision Summary Document(PDF, 117KB)

• Flexible Spending Account Information(PDF, 620KB)
• Flexible Spending Account Enrollment Form(PDF, 100KB)

Platinum Plan Excellus BCBS Summary Document(PDF, 155KB)

• Rates
  • Individual Per Pay Period $ 83.84
  • Family Per Pay Period $217.99
• Rx co-pay: $5/$35/$70, 2x @ Mail

Health Insurance Enrollment Form and Dependent Eligibility Verification(PDF, 1007KB)

• Dutchess Dental Summary Document(PDF, 191KB) - 2024 Rate: $167.00/Month (100% Employee Paid)
• Excellus BCBS Dental Blue Options - Low Option Summary Document(PDF, 96KB) - 2024 Rates: $36.67/Month Individual; $96.35/Month Family (100% Employee Paid)
• Excellus BCBS Dental Blue Options - High Option w. Ortho Summary Document(PDF, 97KB) - 2024 Rates: $45.77/Month Individual; $120.26/Month Family (100% Employee Paid)
• Dutchess Dental/Platinum Vision Enrollment Form(PDF, 176KB)
• Excellus BCBS Dental Blue Options Enrollment Form(PDF, 606KB)

2024 Rate: $24.34 Per Month (100% Employee Paid)

• Platinum Vision Summary Document(PDF, 117KB)

• Flexible Spending Account Information(PDF, 620KB)
• Flexible Spending Account Enrollment Form(PDF, 100KB)