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2012/2013 Open Enrollment Information

posted Nov 16, 2012, 11:36 AM by Wasiewicz, Mark

2012/2013 Open Enrollment Information

Until December 1st, Univera requests employees contact the representatives below for any questions about our new Univera medical insurance plan.

Jan Kurpiewski
Account Manager / Univera Healthcare
205 Park Club Lane, Bflo, NY 14221
phone: 716-857-4668
fax: 716-847-1257

The 2012/2013 Open Enrollment Packet is available to view and/or print, see link below.

Forms must be submitted to the Human Resources Department no later than Friday, November 9th, 2012. Forms submitted after November 9th and before November 26 will still be processed however, you may not receive your new insurance card before December 1st.

Summary of Forms Needed to be Returned
  • Benefit Election Form - Required for all eligible full time staff members
Medical Insurance
  • Univera Enrollment Form - Required for enrollment in the new Univera Medical Insurance Plan
  • Premium Reduction Election Form - Family Plan Participants ONLY
"OPT OUT" Participants
  • Complete the Benefit Election Form and choose "OPT OUT" option.
  • Submit "Proof of Insurance" as described in the Benefit Election From
  • Submit the "Waiver of Coverage" Form
Health Reimbursement  Account (HRA - STEL Funded Dollars)
  • NO Enrollment Form Required
Flexible Spending Account (FSA - Staff Member Funded Dollars) - OPTIONAL
  • Independent Health Flexible Spending Account Enrollment Form - Optional, only complete if you elect to participate in the FSA plan.
Questions about the Univera insurance plan, Health Reimbursement Account, Flexible Spending Account or how all three plans work together, please call:

Mark Wasiewicz, Human Resources Director 
716-366-7792 x212


Krystal Waite, GBDS
Employee Benefits Consultant
Veracity Benefits
716 487-4760