Non-Medicare Open Enrollment (FY2022)

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

Open enrollment is active April 5th through May 14, 2021. 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: enrollments@needhamma.gov

School Employees: HRPayrollHelpDesk@needham.k12.ma.us

FY2022 Rates - Health, Dental & Group Life

FY22 Rate Chart - Effective July 1, 2021

FY21 Rate Chart - Effective July 1, 2020

Group Life Rates

FY2021 Comparison Charts

Medical	Dental	Vision
Qualified High Deductible Health Plans	High vs. Low Plans	EyeMed Plan Summary
Benchmark Plans	High vs. Low Plans
High Deductible and Benchmark

Enrollment Forms

Fallon Community Health Plan	Harvard Pilgrim Health Care
Blue Cross/Blue Shield	Tufts Health Plan
Delta Dental	EyeMed Vision
Health Savings Account (HSA)	Flexible Spending Account (FSA)
Life Insurance application	Opt-Out Form
Life Insurance EOI Life Insurance EOI HIPAA Release	Declination Form

Enrollment Forms in Spanish

Fallon Community Health Plan

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
Fallon Community Health Plan	SelectCare: 5550868 DirectCare: 5550865	SelectCare: 5550755 DirectCare: 5550751	1-800-868-5200	Plan: Select Care and Direct Care
Harvard Pilgrim Health Care	0189920008	0288480016	1-800-782-3675	Plan: HMO or PPO
Tufts Health Plan	57527-114	45843-114	1-800-462-0224	Plan: HMO
Blue Cross/Blue Shield	00-4062726	00-4053585T	1-800-262-BLUE	Plan: HMO Blue New England
Delta Dental	High Plan: 010815-9902	Low Plan: 010815-9901	1-800-872-0500	Plan: Delta Dental PPO Plus Premier
EyeMed	1025891		1-888-4-EYEMED	Network: Insight

Opt-Out Program

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

Health Savings Account (HSA) Info

HSA Guidebook	HSA Election Form
Health Equity Plan Comparison Tool	General info on HSA/QHDHPs

Flex Spending Account (FSA) Info

FSA Election Form (FY22)		Flexible Spending Account Overview (Spanish)
Flexible Spending Account Overview	FSA Frequently Asked Questions	Flexible Spending Account Overview (Spanish)
Eligible Expenses and Election Worksheet	Dependent Care Eligible Expenses	Eligible Expenses and Election Worksheet (Spanish)
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 available by appointment only