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  5. Benefits Information
  6. Benefits Forms

Benefits Forms

Active Employees

Health Insurance

Harvard Pilgrim Health Care (PDF)

Fallon Community Health Plan (PDF)

Blue Cross Blue Shield (PDF)

Tufts Health Plan (PDF)

Other Benefits

Benefits Declination Form (PDF)

Opt Out Program form (must be eligible) (PDF)

Health Savings Account (HSA) Enrollment /Contribution Change Form (PDF)

Flexible Spending Account (FSA) Form (PDF)

Delta Dental (PDF)

Aflac Termination Form (PDF)

EyeMed - Vision Insurance Form (PDF)

Retirees

Non-Medicare Plans

Harvard Pilgrim Health Care (PDF)

Fallon Community Health Plan (PDF)

Blue Cross Blue Shield (PDF)

Tufts Health Plan (PDF)

Medicare Plans

Harvard Pilgrim Medicare Enhanced (PDF)

Fallon Senior Health Plan (PDF)

Blue Cross MEDEX (PDF)

Blue MedicareRx (PDF)

Blue Cross Managed Blue for Seniors (PDF)

Tufts Medicare Supplement PDP Plus (PDF)

Tufts Medicare Preferred HMO (PDF)

  1. Active Employees
    1. Health Insurance
    2. Voluntary Benefits
  2. New Employees
  3. Retired Employees & Surviving Spouses
    1. Health Insurance Open Enrollment Senior Plan (PDF)
    2. Health Insurance Open Enrollment Active Plans (PDF
    3. Medicare Advantage HMO & PFFS Plans (PDF)
    4. Medicare Supplement Plans (PDF)
  4. Summary of Benefits and Coverages
  5. My Medication Advisor
    1. How to Register for myMedical Advisor
    2. Blue Cross Blue Shield Medication List (PDF)
    3. Harvard Pilgrim Medication List (PDF)
    4. Tufts Medical Medication List (PDF)
    5. Fallon Health Medication List (PDF)
  6. Health Rates
    1. FY2019 Health Insurance Rates (PDF)
    2. FY2018 Health Insurance Rates (PDF)
    3. CY2018 Medicare Supplement Rates (PDF)
  7. HIPAA Privacy (PDF)
  8. Injured While on Duty
  9. Other Benefits
    1. Aflac Insurance
    2. Credit Union Membership
    3. Deferred Compensation
    4. Direct Deposit
    5. Employee Assistance Plans
    6. Section 125 Plan
  10. Group Insurance Policy (PDF)
  11. Benefits Forms
  12. Special Enrollment Period! - Dental & Vision
  13. OptiMed Health Partners
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Contact Us

  1. Needham Town Hall
    1471 Highland Avenue
    Needham, MA 02492
    Phone: 781-455-7500

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FAQs

  1. How can I serve on a town board or commission?
  2. How do I request public records from the Town?
  3. Where can I register for parks and recreation programs?
  4. How can I dispose of my recyclable materials?
  5. Does the Town of Needham provide notary services?
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