Employee Benefits

Blueshield of Northeastern New York

• Blue Shield Summary Plan Description (PDF)

Summary of Benefits and Coverages (SBC) :

• Highmark Blueshield SBC 2022 Class 0001 (PDF)
• Highmark Blueshield SBC 2022 Class 0002 (PDF)
• Highmark Blueshield SBC 2022 Class 0003 (PDF)
• Highmark Blueshield SBC 2022 Class 0004 (PDF)

Preferred Provider Organization (PPO) Plans:

• PPO 898 10 Plan - 1 and 3 Rx Plan (Class 0001) (PDF)
  PPO 898 Class 0001 Benefit Summary (PDF)
• PPO 898 10 Plan - 5 and 10 Rx Plan (Class 0003) (PDF)
  PPO 898 Class 0003 Benefit Summary (PDF)
• PPO 898 20 Plan (Class 0002) (PDF)
  PPO 898 Class 0002 Benefit Summary (PDF)
• PPO 898 25 Plan (Class 0004) (PDF)
  PPO 898 Class 0004 Benefit Summary (PDF)

Davis Vision:

• Davis Vision Benefit Summary (Class 0001 and 0003) (PDF)
• Davis Vision Benefit Summary (Class 0002) (PDF)
• Davis Vision Benefit Summary (Class 0004) (PDF)

Delta Dental

• Delta Dental Evidence of Coverage (PDF)

Capital District Physicians' Health Plan (CDPHP)

• CDPHP Certificate of Coverage (PDF)
• CDPHP 2022 Benefit Summary (PDF)
• CDPHP HMO Summary of Benefits and Coverage (PDF)