Skip to content.
HomeE-ServicesCity GovernmentLiving & WorkingDoing Business
You Are Here: Home > E-Services > Document Center

Benefits Documents

Related Pages: Human Resources » Benefits

Health Plan - Retiree (Medicare) - CY2017

File Name File Size
BCBS Medex - Blue MedicareRx Enrollment 178 kB
BCBS Medex - Blue MedicareRx Formulary 768 kB
BCBS Medex - Blue MedicareRx Mail Order Form 72 kB
BCBS Medex - Blue MedicareRx Summary 1 MB
BCBS Medex - Enrollment 732 kB
BCBS Medex - Summary 530 kB
Fallon Senior Plan Premier HMO - Cover Letter 59 kB
Fallon Senior Plan Premier HMO - Enrollment 159 kB
Fallon Senior Plan Premier HMO - Enrollment Instructions 55 kB
Fallon Senior Plan Premier HMO - Notice of Nondiscrimination 290 kB
Fallon Senior Plan Premier HMO - Quick Reference 156 kB
Fallon Senior Plan Premier HMO - Request for Plan Termination 69 kB
Fallon Senior Plan Premier HMO - Service Area & Network Hospitals 4 MB
Fallon Senior Plan Premier HMO - Star Ratings 42 kB
Fallon Senior Plan Premier HMO - Summary 404 kB
Tufts - Disenrollment Form 19 kB
Tufts - Notice of Privacy Practices 138 kB
Tufts - Utilization Management 77 kB
Tufts Medicare Complement - Discrimination is Against the Law 301 kB
Tufts Medicare Complement - Enrollment 164 kB
Tufts Medicare Complement - Member Discounts 510 kB
Tufts Medicare Complement - Summary 86 kB
Tufts Medicare Complement PDP - Formulary 1 MB
Tufts Medicare Complement PDP - Group Election Form 551 kB
Tufts Medicare Complement PDP - Highlights 160 kB
Tufts Medicare Complement PDP - Summary 588 kB
Tufts Medicare Preferred - Appeals and Grievances 79 kB
Tufts Medicare Preferred HMO - Cover Letter 28 kB
Tufts Medicare Preferred HMO - Doctor Search 1 MB
Tufts Medicare Preferred HMO - Enrollment 200 kB
Tufts Medicare Preferred HMO - Formulary 1 MB
Tufts Medicare Preferred HMO - Group Election Form 551 kB
Tufts Medicare Preferred HMO - Healthy Living Essentials 179 kB
Tufts Medicare Preferred HMO - Rx Plus Drug Addendum 187 kB
Tufts Medicare Preferred HMO - Rx Plus Highlights 181 kB
Tufts Medicare Preferred HMO - Silver Sneakers 593 kB
Tufts Medicare Preferred HMO - Star Ratings 137 kB
Tufts Medicare Preferred HMO - Summary 623 kB

Dental

  • Available to all benefit eligible employees.
  • ONLY Retirees can have a two person plan.
File Name File Size
Enrollment - Altus - Active Employee 140 kB
Enrollment - Altus - Retiree 138 kB
Highlights - Altus - High Option 167 kB
Highlights - Altus - Low Option 164 kB
Notice - Altus - Maximum Carry Over Provision 265 kB
Notice - Altus - Online Management 163 kB
Student Certification - Altus 39 kB

Vision

  • Available to all benefit eligible employees and retirees.
File Name File Size
Enrollment - UnitedHealthcare Vision - FY2017 82 kB
FAQs - UnitedHealthcare Vision 29 kB
Network - UnitedHealthcare Vision 164 kB
Summary - UnitedHealthcare Vision 4 MB
E-Services
© 2017 | Copyright City of Worcester, MA | All Rights Reserved. | Login | Disclaimer | Site Map