FY2025 Open Enrollment Information

Open Enrollment- FY 2025, Effective July 1, 2024

For Employees, Non-Medicare Eligible Retirees and Dependents, and COBRA Participants

Open Enrollment for FY2025 will be held this year from May 1, 2024 through May 24, 2024. During this period you may choose or change group health insurance coverage and/or elect to participate in a flexible spending account (FSA).

Rate Charts

• Town Employees
• School Employees
• Retirees
• Cobra

Regulation Regarding Retiree Health Insurance Eligibility

HIPAA Notice of Privacy Practices

Notice of Available Coverage- Women’s Health and Cancer Rights Act Notice

Medicare D- Important Information About Your Health Insurance

Medicaid and the Children’s Health Insurance Program (CHIP) Offer Free or Low-Cost Health Coverage to Children and Families

Section 125 Premium Only Cafeteria Plan Document

Section 125 Enrollment/Waiver Form

Health Insurance Opt-Out Information

• FY 2025 Opt Out Memo
• Health Insurance Opt-Out Program Policy

Flexible Spending Accounts (FSA)

• Flexible Spending Account Enrollment Form
• FSA Eligible Expenses
• FSA Dependant Care Qualifications
• Acknowledgement
• TASC FSA Glossary of Terms

Harvard Pilgrim Summary of Benefits and Coverage

• Harvard Pilgrim Benefits at a Glance
• Harvard Pilgrim HMO
• Harvard Pilgrim Focus HMO
• Harvard Pilgrim PPO
• Harvard Pilgrim Enrollment Form
• Harvard Pilgrim Fitness Reimbursement
• Harvard Pilgrim Living Well Program

Retiree Senior Plan

• BCBS Medex 2
  • Medex Enrollment Form
  • Blue MedicareRx (PDP) Enrollment Form
• Fallon Senior Plan HMO
  • Enrollment Form
• Tufts Medicare Preferred HMO Prime
  • Enrollment Form

Health Reimbursement Arrangement

• Health Reimbursement Arrangement (HRA) Summary Plan Description
• HRA Reimbursement Procedure
• HRA Claim Form

Delta Dental Premier

• Delta Dental Premier Voluntary Enhanced Table Plan
• Delta Enrollment Form 
• Amplifon Hearing Health Care Discount
• Sonic Discount

Deferred Compensation Plans

• Massachusetts Deferred Compensation SMART PLAN
  • Online Enrollment Instructions
  • 2024 Contribution Limits
• ICMA-Mission Square Retirement Deferred Compensation Plan
  • Online Enrollment Instructions

If you wish to enroll in or change Health or Dental plans and/or a Flexible Spending Account (FSA), or need additional information, please contact the Treasurer’s Office at Town Hall at (508)393-5047. Please note that if no change is made to your current health or dental plan selection, no further action or completion of any insurance form is required. However, if you wish to contribute to a FSA for the period of July 1, 2023 through June 30, 2024, you must complete a new FSA enrollment form.