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: 
School Employees: 

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

EyeMed Plan Summary

High Deductible and Benchmark

Enrollment Forms

Fallon Community Health PlanHarvard Pilgrim Health Care
Blue Cross/Blue ShieldTufts Health Plan
Delta DentalEyeMed Vision (vendor only allows 1st of month enrollments)
Health Savings Account (HSA)Flexible Spending Account (FSA)
Life Insurance applicationOpt-Out Form
Life Insurance EOI
Life Insurance EOI HIPAA Release
Declination Form

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
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
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