FY22 Health Benefits Rates 

• Health and Dental Insurance Rates

Health Plan Enrollment Forms

• Blue Cross Blue Shield Enrollment Form
• HPHC Enrollment Form

FY22 Benefit Summaries

• BCBS Blue Care Elect PPO Benefits & Coverage
• BCBS Blue Care Elect PPO Summary of Benefits
• BCBS Access Blue (High Ded w/HSA) Benefits & Coverage
• BCBS Access Blue (High Ded w/HSA) Benefits Summary
• BCBS Network Blue HMO 250/750 Benefits & Coverage
• BCBS Network Blue HMO 250/750 Benefits Summary
• HPHC High Ded. w/HSA Plan Information
• HPHC 250/750 Plan Information
• HPHC Cost Estimator Information

Benefit Comparison

• FY22 Health Plan Comparisons

Altus Dental Coverage

• Altus Dental Plan Summary - Low Plan
• Altus Dental Plan Summary - High Plan
• Altus Dental Maximum Carryover Flyer
• Altus Two-tier Dental Enrollment Form

EyeMed Vision Coverage

• EyeMed Benefit Summary
• EyeMed Enrollment Form

Health Savings Account (HSA) Information

• HealthEquity Website
• Blue Cross Member Portal
• Harvard Pilgrim Member Portal
• Beneficiary Form
• Electronic Funds Transfer Form
• HealthEquity Payroll Deduction Form FY22

FY22 Flexible Spending Accounts (FSA)

Our FSA plan runs from July 1, 2021 thru June 30, 2022. Open enrollment runs from April 1 thru May 25, 2021.  You may sign up for a Health Care and/or a Dependent Care Account.

• The maximum amount you can put away for your Health Care Account is  $2,750. THe Dependent Care Maximum is $5,000 per household.
• You must enroll and fill out new paperwork each year; the FSA does not renew automatically. Existing participants can re-new online here. New Enrollees must complete the FSA Enrollment form below and submit to Cafeteria Plan Advisors.

• Flexible Spending Information
• Flexible Spending Enrollment Form
• Health Care Eligible Expenses
• Health Care Newly Eligible Expenses
• Dependent Care Form 

Employee Assistance

• MIIA Employee Assistance Program

FY22 Investment Opportunities

• 403(b) Plan Information
• 403(b) Vendor List
• 403(b) Plan Highlights
• TSA Transaction Information Form
• TSA Salary Reduction Form
• TSA Online Salary Reduction Agreement System
• 457 Plans—Contributing Through Two Plans

FY22 Insurance Benefits

• Voluntary Life Insurance
• Cancer Expense Brochure
• Cancer Expense Rate Sheet
• Accident Insurance Brochure
• Universal Life Insurance Brochure
• Disability Insurance Brochure

2021 Retiree Health Insurance (65 and over)