Health and Insurance Benefit Information

Plan Year FY2024 (7/1/23 to 6/30/24)

Dental, Vision, & Basic Life Rates 

FY24 Rate Chart - Effective July 1, 2023
FY23 Rate Chart - Effective July 1, 2022
FY22 Rate Chart - Effective July 1, 2021
Voluntary Term Group Life Rates

FY24 Virtual Overview Session Recordings

Enrollment Forms

Harvard Pilgrim Health CareLife Insurance EOI HIPAA Release
Blue Cross/Blue ShieldTufts Health Plan
Delta DentalEyeMed Vision(vendor only allows 1st of month enrollments)
CY23 Health Savings Account (HSA) 
CY24 Health Savings Account (HSA)
FY24 Flexible Spending Account (FSA)
Life Insurance applicationOpt-Out Form
Life Insurance EOIDeclination Form

Enrollment Forms in Spanish

Blue Cross Blue Shield

Where to Submit Enrollment Materials

Town Employees: 

School Employees: Upload securely via TalentEd Records (or contact to for instructions)

Opt-Out Program

Program Requirements (PDF) / Enrollment Form (PDF) / Declination Form (PDF)

Insurance Carrier Information

When making insurance enrollment decisions, always consult your healthcare provider and ensure they are within the specific plan’s network or click the "Find a Provider" link below. You may also reach out to the insurance carriers directly, via the Member Services number below, to ask specific coverage questions under the plans offered by the Town. Mention that you are a "prospective member" and be ready to reference the specific Group Number as specified below. If you need further assistance or clarification, please reach out to your HR Department and we may be able get further information from our Insurance Account Representative on your behalf.
Insurance Carrier
Summary of Benefits
(Qualified High Deductible)
Summary of Benefits (Benchmark)
Summary of Benefits
Summary of Benefits 
(Limited Network)
Member Services
Find a Provider




High Deductible     00-4070363

1-800-262-BLUE (select prompt 3)
High Plan:
Low Plan:



Health Savings Account (HSA) Info

HSA GuidebookHSA Election Form
Health Equity Plan Comparison ToolGeneral info on HSA/QHDHPs

Flex Spending Account (FSA) Info

Flex Spending Account OverviewFlex Spending Account Overview (Spanish)
FSA Eligible ExpensesFSA Store
Dependent Care FSADependent Care FSA (Spanish)

Other Benefits

AflacDelta Dental: Right Start 4 KidsPinnacleCare
CanaRx Prescription Drug Program (see more for $0 co-pays!!)Diabetes Care Rewards ProgramPinnacleCare FAQ's

Legal Notices

125 Summary Plan Document / Affordable Care Act - Market Place Notice (PDF) / CHIP Notice (PDF) / HIPAA Privacy Notice (PDF) / COBRA Notice (PDF) / HIPAA Special Enrollment Rights (PDF) / Notice of Patient Protections (PDF) / Summary of Benefits and Coverage (SBC) (PDF) / Women’s Health and Cancer Rights Act (WHCRA) (PDF) / Summary of Benefits and Coverage (SBCs)

Please visit the West Suburban Health Group website for additional insurance information

HR Benefits Office Hours available by appointment only