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Bald Eagle Area School District Staff Payroll and Benefits Information and Forms

Medical and Prescription Insurance

The District currently offers a PPO Plan through Highmark Blue Shield.  Please see below for additional information.

Highmark PPO Blue Benefits Booklet

Highmark PPO Blue Member Change Form

Highmark PPO Blue Benefits Summary

Summary of Benefits & Coverage - PPO Blue

Glossary of Health Coverage and Medical Terms

2018 Preventive Schedule - Highmark BS

Medical Insurance Coverage & Certification for Spouse Form

Medical Insurance Waiver Form

Creditable Coverage notice

The District annually distributes the Creditable Coverage Notice to participants in the Prescription Drug plan.  If you and/or your covered dependent(s) are not Medicare eligible, then this notice is for informational purposes only.  However, if you and/or your covered dependent(s) are Medicare eligible, then please read the information contained in the Notice carefully, so that you and your dependents can make informed decisions regarding prescription drug coverage.

Creditable Coverage Notice

Dental Insurance

The District currently offers dental insurance through Delta Dental of Pennsylvania.  Please see below for additional information.

Cooks & Custodians (Employee) Delta Dental Benefits Booklet

Cooks & Custodians (Dependent) Delta Dental Benefits Booklet

Teachers, Administrators & Clerical (Employee) Delta Dental Benefits Booklet

Teachers, Administrators & Clerical (Dependent) Delta Dental Benefits Booklet

Delta Dental of Pennsylvania Claim Form

Vision Insurance

The District currently offers vision insurance to employees only through Davis Vision.  Please see below for additional information.

Davis Vision Plan Benefit Description

Davis Vision Care Enrollment Form

Davis Vision Direct Reimbursement Claim Form

Payroll Forms

IRS Form W-4

Change of Address Form

Direct Deposit Form

FMLA Leave Request Form

Short-Term Uncompensated Leave Request Form

403(b) Tax Sheltered Account Program

Flexible Spending Account (FSA) Summary Plan Description

Flexible Spending Account (FSA) Forms

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