Non-Medicare Open Enrollment (FY2021)

Health, Flex Spending, Dental, Vision, Life and others

Open enrollment is active now through May 15, 2020. Updates and changes can be made by completing the applicable plan forms and returning via email to your Human Resources Department. Please contact Human Resources with any questions.

Enrollment Email Addresses

Town Employees: 
School Employees: 

FY2021 Rates - Health, Dental & Group Life

FY21 Rate Chart - Effective July 1, 2020 
FY20 Rate Chart - Effective July 1, 2019

Group Life Rates

FY2021 Comparison Charts

EyeMed Plan Summary

Enrollment Forms

Fallon Community Health PlanHarvard Pilgrim Health Care
Blue Cross/Blue ShieldTufts Health Plan
Delta DentalEyeMed Vision
Health Savings Account (HSA)Flexible Spending Account (FSA)
Declination Form

Life Insurance application
Opt-Out Form
Life Insurance EOI
Life Insurance EOI HIPAA Release

Enrollment Forms in Spanish

Blue Cross Blue Shield

Tufts Health Plan

Insurance Carrier Information

When making insurance enrollment decisions, always consult your healthcare provider and ensure they are within the specific plan’s network or click the "Find a Provider" link below. You may also reach out to the insurance carriers directly, via the Member Services number below, to ask specific coverage questions under the plans offered by the Town. Mention that you are a "prospective member" and be ready to reference the specific Group Number as specified below. If you need further assistance or clarification, please reach out to your HR Department and we may be able get further information from our Insurance Account Representative on your behalf.
Insurance Carrier
Summary of Benefits
(Qualified High Deductible)
Summary of Benefits (Benchmark)
Member Services
Find a Provider
High Plan:
Low Plan:

Opt-Out Program

Program Requirements (PDF) / Enrollment Form (PDF) / Declination Form (PDF)

Health Savings Account (HSA) Info

HSA Guidebook

Health Equity Plan Comparison Tool

Flex Spending Account (FSA) Info

FSA Overview / Eligible Expenses List / West Suburban Health Group (WSHG) Information on HSA/QHDHPs

Summary Plan Document (7/1/18 - 6/30/19)

Summary Plan Document (7/1/19 - 6/30/20)

Other Benefits

NEW!: MyTeleMedicine

Diabetes Care Rewards Program

CanaRx Prescription Drug Program (see more for $0 co-pays!!)

Legal Notices

Affordable Care Act - Market Place Notice (PDF) / CHIP Notice (PDF) / HIPAA Privacy Notice (PDF) / COBRA Notice (PDF) / HIPAA Special Enrollment Rights (PDF) / Notice of Patient Protections (PDF) / Summary of Benefits and Coverage (SBC) (PDF) / Women’s Health and Cancer Rights Act (WHCRA) (PDF) / Summary of Benefits and Coverage (SBCs)

Please visit the West Suburban Health Group website for additional insurance information

HR Benefits Office Hours (Appointments encouraged)

Tues, Weds, Thurs, 1:00pm to 4:30pm