Employee Benefits

Employee Benefits - Forms and Information


Machine-Readable Price Transparency Files

As part of the Consolidated Appropriations Act (CAA), new Transparency in Coverage rules have been established by the Centers for Medicare & Medicaid Services (CMS).  A multi-year initiative that requires health plans to share contracted prices for all health care items and services. The first phase of these requirements begins July 1, 2022.

To comply with the Transparency in Coverage rule, as a self-funded employer group, Canastota Central School District is required to share this information. Excellus BlueCross BlueShield (BCBS) has provided the below link to their website where the following information will be available:

In-network provider contracted rates for items and services

Out-of-network allowed amounts and billed charges for items and services


Please note that these files are designed for developers or data aggregators and are not consumer friendly. Members are encouraged to use the Excellus BCBS Estimate Medical Costs Tool instead.


Excellus Health Insurance Group Enrollment Form

Documentation Required for Verifying Dependent Eligibility
Provides a check list of documents required to verify the eligibility of dependents enrolling in a health plan.

Dental and Vision Enrollment for NY

Ameritas Vision Group Reimbursement Claim Form

CSEA Short Term Disability
This is a Notice and Proof of Claim for Disability Benefits. Use this form if you become sick or disabled while employed or if you become sick or disabled within four weeks after terminiation of employment.

Leave for Cancer Screening Form
The Canastota Board of Education Policy and Form for requesting time off for cancer screening. This form must be submitted three or more work days in advance of the requested time off.

Leave for Cancer Screening
The Canastota Board of Education Policy on leaving for a cancer screening.

Employee Rights and Responsibilities
Discusses the rights and responsibilities of employees under the Family and Medical Leave Act.

403(b) Universal Availability Notice 2014
A notice discussing retirement by participating in a 403(b) retirement plan.

Link to our 403B Participating providers Here