New Hire Benefits

Below are the forms you will need to enroll in or decline Health and Life Insurance.

Spouses & Dependents

Please note: To enroll a spouse you must include a copy of your city or town issued marriage certificate or your divorce decree and a copy of their Social Security Card. To enroll dependent children under age 26 you will need to include birth certificates, adoption forms or guardianship papers and a copy of their Social Security Card.

Applications

All applications and accompanying paperwork must be received by the Benefits Coordinator in the Town Manager's Office within 30 days of your hire date.  

If you do not enroll during your initial enrollment window your next opportunity will be during the annual Open Enrollment with the coverage effective date of July 1st, unless you experience a qualifying event.

Plan Information

  1. FY24 Active Rates
  2. 2023-2024 Active Employee Payroll Agreement Form
  3. 2023-2024 NM Retiree-SS Payroll Agreement Form
  4. FY24 Benchmark Comparison Chart
  5. FY24 HSA Comparison Chart
  6. FY24 Combined Comparison Chart
  7. Health Savings Account "HSA" Information for High Deducible - Health Equity
  8. Optional Life Insurance Summary - Boston Mutual
  9. Life Insurance FAQ - Boston Mutual
  10. Basic Life and AD&D Insurance Summary - Boston Mutual
  11. Optional Life Insurance Rates - Boston Mutual

Forms

  1. Insurance Declination Form
  2. Life Insurance Enrollment Form
  3. 2023 Health Equity Payroll Deduction Form

Insurance Company Applications

  1. Blue Cross Blue Shield Enrollment Form
  2. Harvard Pilgrim Enrollment Form
  3. Tufts Enrollment Form

Notices

  1. ACA Health Insurance Marketplace Notice
  2. HIPAA Privacy Notice
  3. Initial COBRA Notice
  4. Medicaid-CHIP Notice
  5. Medicare Part D Creditable Coverage Notice
  6. Medicare Eligibility