Core Benefits
MEDICAL BENEFITS
Provided by Blue Cross Blue Shield of Rhode Island
Blue Cross Blue Shield Enrollment Form
Local – (401) 459-5000
Out of state residents – 1-800-369-2227
Website: www.bcbsri.com
THE UNIFORM SUMMARY OF BENEFITS AND COVERAGE (SBC) IS A LEGALLY REQUIRED HEALTH PLAN DISCLOSURE DOCUMENT
BLUE CROSS SUMMARIES
Medical Policy: Gender Reassignment Surgery
DENTAL BENEFITS
Provided by Delta Dental of RI
Delta Dental Enrollment Form
Billing – (401) 752-6200
Enrollment – (401) 752-6234
Customer Service – (401) 752-6100
Website: www.deltadentalri.com
DELTA DENTAL SUMMARIES
Active Fire Union Delta Dental Co-Max Flyer
Active Fire Non-Union Delta Dental Co-Max Flyer
PRESCRIPTION BENEFITS
Provided by CVS Caremark
Customer Service: 1-888-790-8070
Website: www.caremark.com
CVS CAREMARK SUMMARIES
VISION BENEFITS
Provided by Blue Cross Blue Shield of RI
Fire Union
- One annual routine eye exam per calendar year with co-payment under medical policy
Fire Non-Union
- One annual routine eye exam per calendar year with co-payment under medical policy
- Prescription glasses (lenses and or frames) or contact lenses are covered up to a maximum of $100 per -calendar year. Members pay the full charge whether using a participating or non-participating provider and files claim to BCBSRI for reimbursement
QUALIFYING EVENT
A life event that allows you to make changes to your current health plan
*ALL CHANGES MUST BE SUBMITTED WITHIN 30 DAYS OF THE QUALIFYING EVENT WITH THE PROPER DOCUMENTATION
- Qualifying Events include: Marriage/Birth/Adoption/Loss of coverage
- Documentation: Marriage License/Birth Certificate/Adoption papers/ HIPAA letter
OPEN ENROLLMENT
Open Enrollment occurs annually and allows you to alter your current health plan
- City Open Enrollment – June 1-30 for effective date of July 1, 2019
Voluntary Benefits
DAVIS VISION – NON-UNION
Davis Vision Reimbursement Form
BASIC AND SUPPLEMENTAL LIFE INSURANCE – ADMINISTRED BY THE STANDARD
The City provides Basic life insurance to Active Police, Fire, and Non-Union employees at the City’s expense. Police and Fire employees are eligible for a $50,000 line of duty benefit at the City’s expense. Supplemental life insurance may be elected during open enrollment at the employee’s cost (cost is based upon employee’s age and coverage amount requested). If requesting over $200,000 in additional coverage, the Evidence of Insurability Form needs to be completed and sent directly to the Standard.
a. Beneficiary Form
b. Supplemental Enrollment Form
c. Evidence of Insurability Form
d. Continuation of Coverage & Portability Form
e. Summary for Fire
f. Summary for Fire Non-Union
g. Line of Duty Benefit for Police and Fire
j. Basic and AD&D Life Insurance Booklet
k. Additional Life Insurance Booklet
FLEXIBLE SPENDING ACCUNT (FSA)
Healthcare and Dependent Daycare – Flexible Spending Account – Administered by TASC
Open Enrollment June 1 – 30, 2019 for effective date of July 1, 2019
a. Enrollment Form
b. Advantages of an FSA
c. Dependent Care Qualifications
d. FlexSystem Eligible Expenses
e. MyCash Manager Guide
f. MyTASC Mobile Guide
FLU SHOTS
Employees and retirees can receive the flu vaccine at a local pharmacy by presenting their Blue Cross Blue Shield Card.
COORDINATION OF BENEFITS
Active Coordination of Benefits Form
Applies to spouses/qualified ex-spouses of active employees who have access to health coverage through his/her employer. Working spouses/ex-spouses must enroll in an individual plan with his/her employer. You as the employee will be reimbursed in your bi-weekly paycheck the cost that your spouse gets deducted out of his/her paycheck.
- Your spouse/ex-spouse remains enrolled in full coverage with the City.
- Your spouse/ex-spouse is enrolled in his/her employer’s plan as primary and the City’s plan as secondary.
- You are reimbursed for the cost of the plan (co-share) that your spouse/ex-spouse pays out of his/her paycheck.
- Whatever the spouse’s/ex-spouse’s employer ‘s plan does not cover, the City’s plan covers.
- If the only plan available to a working spouse is an HSA, the spouse does not need to enroll (proof/documentation required)
- Proof and cost of coverage required – see FAQ for details
