Employee Benefits

Consolidated Personnel By-Law 2023

Employee Forms

• Employee Information Change Form (PDF)
• Form W-4 (PDF)
• Form M-4 (PDF)

The Annual Open Enrollment period is the ONLY time that you may change health insurance plans or make changes to your existing plans (including canceling) without a qualifying event. (Changes/cancellation requests must be made within 30 days of a qualifying event)

Health Insurance

• Pre/Post Tax Deduction Notice (PDF)

The only time you may enroll (or cancel) benefits is at Open Enrollment unless you have a Qualifying Event.

Qualified changes in status include: marriage, divorce, legal separation, birth or adoption of a child, change in child's dependent status, death of spouse, child or other qualified dependent, change in residence due to an employment transfer for you or your spouse, commencement or termination of adoption proceedings, or change in spouse's benefits or employment status. Please provide proof of change within 30 days of Qualifying Event.

• Rate Letter (PDF)
• Blue Cross Enrollment Form (PDF)
  • Required Documentation:
    • If adding spouse - copy of Marriage Certificate
    • If adding birth child - copy of Birth Certificate(s)
    • If adding an adopted child or legal guardianship of child - copy of court document showing custody
    • If adding a divorced spouse - copy of Divorce Decree showing requirement to cover an ex-spouse
• HMO and PPO Plan Design Comparison (PDF)
• Network Blue New England Summary (PDF)
• Network Blue New England Summary of Benefits and Coverage (PDF)
• Blue Care Elect Summary (PDF)
• Blue Care Elect Summary of Benefits and Coverage (PDF)
• Blue Cross Blue Shield Plan Info
• Telehealth Member Brochure (PDF)
• Weight Loss and Fitness Reimbursement Forms
• Non Hospital Imaging Centers (PDF)
• Emergency Room Alternatives (PDF)
• Nurse Hotline (PDF)
• Step In Program (PDF)
• My Blue Member App (PDF)
• Using Find A Doctor (PDF)
• Understanding Your Deductible (PDF)
• Summary of Health Plan Payments Guide (PDF)
• Health Insurance Opt Out Form (PDF)
• Step In Program (PDF)
• Diabetes Care Value Program (PDF)

Optional Insurance

• Boston Mutual Rates (Basic Life and Voluntary Life) (PDF)
• Boston Mutual Basic Life Update 8/21/23 (PDF)

The only time you are eligible to enroll in Basic Life Insurance is at date of hire. You are not eligible for Voluntary unless you elect Basic Life.

• Boston Mutual - Accident Plan (PDF)
• Colonial Life (PDF)
  • Colonial Life - Appointment Scheduler (PDF)
• Aflac (PDF)
  • Aflac - Insurance Options
  • Aflac - Appointment Scheduler (PDF)
  • Aflac Insurance Products

Other Benefits Offered

• EAP Perspectives (PDF)
• United Way (PDF)

General Information

• FMLA General Guidelines (PDF)
• COBRA Continuation Coverage (PDF)
• Patient Protection Disclosure (PDF)
• HIPPAA Notice of Privacy Practices (PDF)
• Women's Health and Cancer Rights Act (PDF)
• Premium Assistance (CHIP) (PDF)
• The Uniformed Services Employment and Reemployment Rights Act (USERRA) (PDF)
• MCAD Pregnant Workers Fairness Act (PDF)

Quick Links

• Blue Cross Blue Shield
• Atlus Dental
• CanaRx
• TeleHealth
• A Healthy Me
• Boston Mutual
• Aflac
• Colonial Life

Deferred Compensation Plans (457)

• Great West
• Nationwide

Miscellaneous

• Cafeteria Plan Advisors Open Enrollment held in December of each year with effective date of January 1
• Perspectives Employee Assistance Program

Username: MEGA

Password: perspectives

Retirement

• Bristol County Retirement