• Benefit Information

     

    Health Insurance

     

    Form Name Form/Flyer Information
    • Health Insurance Empire Plan “Summary of Benefits and Coverage”

      (What our Plan covers and what you pay for covered services) 
    		 Download
    • Health Insurance Empire Plan “At A Glance”
       
      (Health insurance benefits information for active employees, retirees, vestees and dependent survivors) 
    		 Download
    • Health Insurance Empire Plan “Preferred Drug List”
    		 Download
    • Health Insurance Empire Plan “On The Road”
    		 Download
    • Required Exchange Marketplace Notification to Employees
    		Download

     

     

    Disability

     

    The information below references disability benefits for our POB employees.

     

    Form Name Form/Flyer Information
    • Understanding what disability is –
      Frequently Asked Questions and Answers Flyer

      (This flyer will give a summary to everyone of what disability is, when to file and what to expect).
    		 Download
    • Form DB-120 Notice of Compliance is posted in a visible location in each building.
    		 Download
    • Form DB-271 – Statement of Rights for disability insurance.
    		 Download
    • Form DB-450 – the actual claim form that the employee is responsible for completing.  As an employer, you will need to complete part C of this form.
    		 Download