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Non-Medicare Open Enrollment (FY2019)

As previously announced, the “Rate Saver” health plans will no longer be available to West Suburban Health Group members beginning in Fiscal Year 2019 (July 1, 2018). The Benchmark plans will continue to be available, as well as a Qualified High Deductible Health Plan (QHDHP) with a Health Savings Account (HSA) for eligible employees.
This webpage will continue to be populated with up-to-date information to help you make an informed choice related to health care. Please continue to check this page or schedule an appointment with your Human Resources Department for more information. 

FY2019 Open Enrollment Period:
April 13, 2018 through May 11, 2018 (at noon)

FY19 Benefits Fair!:
Monday, April 23, 2018: 12pm to 5pm
Tuesday, April 24, 2018: 10am to 3pm

Informational Presentations:
*April 5th - 3:30pm to 5:00pm - Powers Hall, Town Hall
*April 19th - 8:30am to 10:00am - Senior Center/Center at the Heights (CATH)
May 2nd - 12:00pm to 1:30pm - Community Room, Library
May 8th - 3:30 to 5:00pm - Powers Hall, Town Hall

 *Spanish Interpretation Available - Please RSVP to HR if interested

NEW: During the Benefits Fair two additional presentations will be held:
April 23rd - 3:00pm to 4:00pm - Selectmens' Chambers, Town Hall
April 24th - 12:00pm to 1:00pm - Selectmens' Chambers, Town Hall

 General Open Enrollment Information

 Enrollment Guide Benefits Fair - Save the Date!
 Informational Presentations Non-Medicare Retiree Announcement 

 Health Plan Information

 Enrollment Forms

Active Employees  /  Non-Medicare Retirees

Enrollment Action Form: 
Employees / Non-Medicare Retirees

Comparison Charts: 
Benchmark / Qualified High Deductible Plan

Carrier Specific Forms:
Fallon Application  /  Harvard Pilgrim Application  / 
Blue Cross/Blue Shield Application  /  Tufts Application

Plan Specific Information
including contact Member Services and SBCs
Forms for Declining Benefits
Declination FormOpt-Out Program Form (must be eligible)

 Flexible Spending Account (FSA)

Enrollment Form FY19 Open Enrollment Announcement 
 FSA Benefit Overview Benefit Strategies, LLC. Resources and Forms
FSA Eligible Expenses Dependent Care Eligible Expenses 
 Summary Plan Document (1/1/18 - 6/30/18) Summary Plan Document (7/1/18 - 6/30/19) 
Health Savings Account (HSA) / High Deductible Health Plan
 Presentation to WSHG on 11/30/17 (VIDEO) PowerPoint Slides from NFP Corp Presentations
 HealthEquity HSA Guidebook  Harvard Pilgrim - Understanding your HSA
 Blue Cross HSA-QHDHP Plan Tutorial Harvard Pilgrim - QHDHP  
 BCBS Preventative Drug List HPHC Preventative Drug List 
FALLON Preventative Drug List  TUFTS Preventative Drug List 
Pro-Rated Method of Calculation (excerpt from HealthEquity HSA Guidebook) 
West Suburban Health Group (WSHG) Information on HSA/QHDHPs

Tools and Resources
For Estimates ONLY 

 QHDHP vs. Benchmark Calculator (Excel Format)

 Online Health Plan Comparison Tool (by HealthEquity)

 HSA Contribution Guide and Tool

Scenarios, results and calculations presented in these tools are example estimates only. Individual results may vary. Nothing in these tools are intended as legal, tax, financial, medical or marital advice. Always consult a professional when making life changing decisions.

Voluntary Benefits

Delta Dental Plan Comparison

 Delta Enrollment Form
 Boston Mutual Life and Accident Insurance


 CanaRx Prescription Drug Program
Benchmark plan members are eligible to participate in the CanaRx program. High Deductible plan members are not eligible to participate in CanaRx at this time.   
 Diabetes Care Rewards Program
Benchmark plan members are eligible to participate in the Diabetes Care Rewards program. High Deductible Plan members are eligible to participate in the Diabetes program; however, only the diabetic medication on the carrier's Preventive Drug List will be available at $0 co-pay. Because Fallon’s Preventive Drug List does not include any diabetic medications or supplies, the Diabetes Care Rewards Program is not eligible for Fallon High Deductible plan members at this time.

 Required Notices

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

Insurance Carrier

 Customer Service

Find a Provider

 Fallon Community Health Plan


Plan: Select Care and Direct Care

 Harvard Pilgrim Health Care


Plan: HMO or PPO

 Tufts Health Plan


Plan: HMO

 Blue Cross/Blue Shield


Plan: HMO Blue New England

Delta Dental  1-800-872-0500  Plan: Delta Dental Premier 
Aflac  Ray DeRosa (Agent): 617-658-1834 NA

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