Insurance Forms and Information

Administrators have the option of four MESSA Plans: MESSA Choices, ABC-1, ABC-2, and Essentials by MESSA.  (see complete summary of benefits under “Insurance Plan Descriptions and Cost).

Please return the following for enrollment:

•         Health Insurance Enrollment Form or Member Change form
•         Life Insurance Beneficiary Form

If you have further questions please email michael.emerson@pontiacschools.orgAdmin Insurance Plans Info and Cost

Admin MESSA Choices

Admin MESSA ABC 1

Admin MESSA ABC 2

Essentials by MESSA

MESSA Essentials Drug List

MESSA Essentials Drug Coverage Booklet

MESSA Enrollment Form

MESSA Member Change Form

LIfe Insurance Beneficiary Form

SPD - Life and ltd

Full-time Food Service Staff have the option of two Blue Care Network HMO Plans.   (see complete summary of benefits under “Insurance Plan Descriptions and Cost). 

Please return the following for enrollment:

• Health Insurance Enrollment Form (remember to specify which plan you are enrolling for on the top of the form)  OR Waiver Form
   
• Life Insurance Beneficiary Form

If you have further questions please email michael.emerson@pontiacschools.org

Food Service Plan Summary and Cost

Blue Care Network Enrollment Form

Food Service Benefits Waiver

Food Service Life Insurance Beneficiary Form

Food Service Blue Care Network $500/$1,000 Deductible Plan

Food Service Blue Care Network HIGH Deductible Plan

Employees in this classification have the option of four MESSA Plans: MESSA Choices $500/$1,000, MESSA Choices-2 $1,000/$2,000 ABC-1, or Essentials by MESSA  (see complete summary of benefits under “Insurance Plan Descriptions and Cost).

Please return the following for enrollment:

•          Health Insurance Enrollment Form or Member Change Form
•          Life Insurance Beneficiary Form

If you have further questions please email michael.emerson@pontiacschools.org

Grant Funded Insurance Summary and Cost

Grant Funded MESSA Choices

Grant Funded MESSA Choices 2

Grant MESSA ABC 1

Essentials by MESSA

MESSA Essentials Drug List

MESSA Essentials Drug Coverage Booklet

MESSA Enrollment Form

MESSA Member Change Form

LIfe Insurance Beneficiary Form

3-tier coverage

SPD - Life and ltd

 

Paraprofessionals and Teacher Assistants have the option of four MESSA Plans: MESSA Choices, MESSA Choices II, ABC-1, or Essentials by MESSA (see complete summary of benefits under “Insurance Plan Descriptions and Cost).

Please return the following for enrollment:

•          Health Insurance Enrollment Form or Member Change Form
•          Life Insurance Beneficiary Form

If you have further questions please email michael.emerson@pontiacschools.org

Insurance Summary and Costs

MESSA Choices

MESSA Choices 2

MESSA ABC 1

Essentials by MESSA

MESSA Essentials Drug List

MESSA Essentials Drug Coverage Booklet

MESSA Enrollment Form

MESSA Member Change Form

LIfe Insurance Beneficiary Form

3-Tier coverage

spd - life and ltd

Police Authority Officers have the option of two HMO plans with Blue Care Network (see complete summary of benefits under "Insurance Plans Descriptions and Cost).

Please return the following for enrollment:

• Health Insurance Enrollment Form (be sure to select a plan) or the Waiver form.
• Life Insurance Beneficiary Form.

If you have further questions please contact michael.emerson@pontiacschools.org 

Insurance Summary and Costs

PAO Health Insurance Waiver

Blue Care Network Enrollment Form

Blue Care network hmo plan

blue care network hmo high deductible plan 

Secretaries have the option of three MESSA Plans: MESSA Choices, MESSA Choices-2 and ABC-1  as well as an Opt Out Plan.

Please return the following for enrollment:

•         Health Insurance Enrollment Form or Member Change Form
•         Life Insurance Beneficiary Form

If you have further questions please email michael.emerson@pontiacschools.org

Insurance Summary and Costs

MESSA Choices

MESSA Choices 2

MESSA ABC 1

MESSA Enrollment Form

MESSA Member Change Form

LIfe Insurance Beneficiary Form

3-Tier coverage

spd - life and ltd

Teachers have the option of four MESSA Plans: MESSA Choices-II, ABC-1, ABC-2, Essentials by MESSA or two Opt Out Options

Please return the following for enrollment:

•         Health Insurance Enrollment Form, Member Change Form or Opt Out Form
•         Life Insurance Beneficiary Form

If you have further questions please email michael.emerson@pontiacschools.org

Insurance Summary and Costs

Teachers MESSA ABC 1

Teachers MESSA ABC 2

MESSA Choices 2

Teacher Insurance Opt Out Form

MESSA Enrollment Form

MESSA Member Change Form

LIfe Insurance Beneficiary Form

3-Tier coverage

Life insurance

LTD Insurance