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Non-Bargaining Lay Employees

All full-time employees are required to complete every form even if they are waiving coverage. Employees are considered full-time if they are regularly scheduled to work thirty or more hours per week.

Employees who want to enroll dependents into the plan must submit proof of eligibility with their enrollment forms.

Benefit Enrollment

Please complete the following form and send it to your local administrator to enroll in the health, dental, and/or vision plans described below.

Benefit Enrollment Form

Health Plan (United Healthcare & CVS Caremark)

Medical and prescription drug coverage is available through United Healthcare and CVS Caremark, respectively, to all employees who meet eligibility requirements. Contact your local administrator to check eligibility. Below are all forms and plan documents associated with our health plan.

2024 UHC Summary Plan Description – Non-Bargaining Lay & Religious

United Healthcare Choice Plan – Summary of Benefits & Coverage

CVS Prescription Benefit Plan Copay Overview

United Healthcare Claim Form

Helpful Links

MyUHC – Member Login | United Healthcare

MyUHC Account Registration

CVS Caremark

Rally Member Journey Flyer (2024)

Real Appeal Overview Flyer (2024)

Virtual Visits Fifty Dollar Flyer (2024)

UHC Flu Shots – Participating Pharmacies

Dental Plan (Cigna)

Dental coverage is available through Cigna to all employees who meet eligibility requirements. Contact your local administrator to check your eligibility. Below are the forms and summary documents associated with our dental plan.

Cigna Dental Benefit Summary (St. Raymond’s Cemetery Employees)

Cigna Dental Benefit Summary (Beacon of Hope Employees)

Cigna Dental Benefit Summary (All Other Groups)

Cigna Dental Claim Form

Helpful Links

My Cigna – Member Login

How to Access Your Digital ID Card

Vision Plan (Davis Vision)

Vision coverage is available through Davis Vision to all employees who meet eligibility requirements. Contact your local administrator to check your eligibility. Below are the forms and summary documents associated with our vision plan.

Davis Vision Plan Benefit Summary

Davis Vision Claim Form

Davis Vision Out-of-Network Claim Form

Helpful Links

Davis Vision – Member Login

Hearing Aid Assistance (Davis Vision)

Eligible employees can receive discounts on hearing aids through Davis Vision. Please see the following documents for more information.

Davis Vision Hearing Tests

Davis Vision Hearing Pricing Sheet

Life Insurance (Hartford)

Please contact your local administrator to begin any life insurance claims.


Basic Term Life Policy (Booklet 1)

Supplemental Term Life & Supplemental Dependent Life Policy


Basic Life Enrollment Form

Supplemental Life Enrollment Form

Disability (Hartford)

Short-Term Disability (STD) is available to all employees in accordance with New York State Disability Law. The coverage is in effect for up to a maximum of 26 weeks in any 52-week period.

Short-Term Disability Policy

Long-Term Disability is available to eligible employees who have completed a minimum of 6 months of service and have exhausted the 26 weeks’ short-term disability period. Contact your local administrator to confirm that you are eligible for long-term disability.

If you would like to apply for disability, please contact your local administrator.

Paid Family Leave (PFL) (Hartford)

Paid Family Leave provides eligible employees job-protected, paid time off in order to; bond with a newly born, adopted, or fostered child; care for a family member with a serious health condition; or assist loved ones when a spouse, domestic partner, child, or parent is deployed abroad on active military service.

New York State Paid Family Leave Statement of Rights

Please contact your local administrator for more information on how to apply for PFL.

Employee Assistance Plan (Hartford)

The Employee Assistance Program provides short-term confidential clinical services to help you and your family address stressful life issues and personal concerns. The program, also known as “Ability Assist,” is administered by Hartford Life Insurance, and there is no cost to you for this benefit. This program offers the following:

  • Legal Support & Resources
  • Financial Information & Resources
  • Health Champion
  • Guidance Resources On-Line

2024 Ability Assist Program Flyer

You can access Ability Assist by phone at 1 (800) 964-3577 or online at

Thank you for visiting our webpage. The benefits team is here to make your health care experience as positive as possible. We will be adding informational notices and other tools to aid you in your health care. Please feel free to view this site often for updates. If you have any questions not addressed by these webpages, please reach out to us via the contact form here.