Elmira CitySchool District

Family, School, Community:Together We Succeed

Health Benefits for Retirees <65 and without Medicare

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MEDICAL INSURANCE:

Excellus Summary of Benefits | July 1, 2024 - June 30, 2025
Excellus 3 Tier (Commercial) Drug Formulary

DENTAL INSURANCE:

Excellus Dental Blue Options| 800-724-1675

Excellus Dental Benefit Summary Effective July 1, 2024
 Excellus Dental Claim Form

As a reminder, Excellus has the most participating dentists than any other dental provider.  All preventive care provided by a participating dentist is covered at 100%.  To find a participating dentist go to Find a Dentist | Excellus BlueCross BlueShield

Vision Coverage:

Davis Vision | Eligible Employee Benefit | 800-999-5431

Davis Vision Plan Highlights

Medicare (P01) ESA PPO Plan Health Benefits for Retirees with Medicare

To reach Aetna directly, please call 1-888-267-2637

Summary of Benefits January 1, 2025 through December 31, 2025
Group Medicare | Aetna Medicare
Aetna Drug Formulary updated 04/01/2025

Get Forms for your Medicare Plan | Aetna Medicare (including dental and vision)
Return completed form by fax: 1-866-474-4040 or
Mail to: Aetna Medicare
PO Box 981106
El Paso, TX 79998-1106

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