To make a change from your existing coverage to another plan, enroll or cancel coverage for yourself or any of your dependents, or to enroll with the town as a new subscriber please complete the Insurance Company's Application/Enrollment Form, found below.
If the change you are making results in a corresponding change to your premium (new, increase or decrease) you also need to complete an Employee Payroll Agreement, found below.
If you are enrolling a dependent for the first time you must include:
For a spouse or ex-spouse: a copy of their Social Security Card and your city/town issued marriage certificate or your divorce decree.
For dependent children under age 26: a copy of their Social Security Card and a birth certificate, adoption or guardianship papers.
All applications and accompanying paperwork must be received by Christine Fowler, Benefits Administrator, in the Treasurer's Office, within 30 days of the qualifying event.