Insurance open enrollment period is from October 27, 2016 to November 23, 2016 for changes effective January 1, 2017.  You are responsible for notifying Lauri Roode regarding the events indicated below: 

  • Wish to change benefit plans.
  • Have changed your address or phone number.
  • Have a change in marital status.
  • Have begun receiving Medicare benefits for yourself or any family member.
  • Wish to enroll yourself and any eligible family members.
  • Wish to enroll or remove a dependent child.

 

DPW, Library, Recreation and Town Hall employees

Benefit Election Form (must be submitted by November 23rd)

Flexible Benefits Enrollment Form

Insurance Application or Change Form

Children’s Health Insurance Program Information

Health Insurance Plan Option Information:

a. AB5(01) RX 10/20/45

b. AB15IPDED(01) RX 10/20/45

c. BC2T10(01) RX 10/20/45

d. BC3T15IPDED(01) 10/20/45

Dental Insurance Plan Option Information:

a. Low Dental Plan

b. Mid Dental Plan

c. High Dental Plan

Police employees

 

Benefit Election Form (must be submitted by November 23rd)

Flexible Benefits Enrollment Form

Insurance Application or Change Form

Children’s Health Insurance Program Information

Health Insurance Plan Option Information:

a. BC2T10(01) RX 10/20/45   

b. BC2T10R3(01) 15M3/7

c. AB15IPDED RX 10/20/45

Dental Insurance Plan Option Information:

a. Low Dental Plan

b. Mid Dental Plan

c. High Dental Plan