Benefits

Benefit Eligible employees are employees that are scheduled to work more than 20 hours per week.

Effective Dates & Enrollment Deadlines

New Hires:  Benefits selected will be effective as of the first day of employment; enrollment information must be received in HR within 30 calendar days of hire date

Position Changes (non-benefit eligible to benefit eligible): benefits will be effective the first date of the new position, enrollment information  must be received in HR within 30 calendar days of the new positon

Position Change (benefit eligible to non-benefit eligible):  benefits will be terminated within 30 days from the date of the new position

Eligible participants:  able to enroll or make policy changes during annual open enrolment or within 30 calendar days of a qualifying event

• Annual Open Enrollment is held during the month of May.  All forms and documents must be submitted by the deadline date.  Changes become effective on July 1st.

All forms and required documents must be submitted within 30 days of the qualifying event

QUALIFYING EVENTS:

• Open enrollment
• Marriage, Divorce
• Death of a spouse for dependent
• Loss of Insurance

DOCUMENTS REQUIRED:

• Marriage certificate - to add spouse
• Divorce decree- to add divorced spouse (providing neither part remarried)
• Birth certificate - to add dependents
• Court order - to add dependents
• Loss of insurance letter

 

Enrollment Procedure

All forms can be found within the specific topics below.  Please print, sign and date forms prior to sending them.

Unless directed otherwise, please send forms to Stacy Stewart in Human Resources.  DO NOT EMAIL.

Options are Fax: 413-667-8739, Interoffice,  US Mail or in Person.

 

 

Dental Enrollment Form

Active Employees

 

BCBS Enrollment form 

Network Blue New England HMO Information

Network Blue New England HMO Summary

Understanding a Network Blue New England HMO Plan

Blue Care Elect Preferred PPO Information

Blue Care Elect Preferred PPO Summary

Understanding a Blue Care Elect Preferred PPO Plan

FY ‘26 Rates Active & Retirees Under 65  

Retirees

 

2026 Medicare Rx Enrollment Form

2026 Medex 2 Summary of Benefits

2026 Medicare RX Summary of Benefits

2026 Blue Care RX Drug Formulary Book

CVS Caremark Mail Service Order Form

 

Boston Mutual Life Insurance Options

Fitness Reimbursement Form

Weight Loss Reimbursement Form

Child Birth Class Reimbursement Form