• Qualifying Events include: Marriage/Birth/Adoption/Loss of coverage
• Documentation: Marriage License/Birth Certificate/Adoption papers/ HIPAA letter

• 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

• One annual routine eye exam per calendar year with co-payment under medical policy

OPT-OUT OF COVERAGE

Employees may forgo Health and Dental Coverage and be eligible for a buy back.  You must submit the form every year during Open Enrollment with a copy of your medical card.  For individual, please provide a copy of your medical card and for family, please provide your medical card and one other family member’s card.

Opt-Out Form

BASIC/AD&D LIFE INSURANCE – Non-Union

Administered by MetLife

The City provides Basic Life& AD&D insurance to Active Police, Fire, and Non-Union employees at the City’s expense.

Portability/Conversion at Termination

You may be eligible to port or convert your basic and your optional life coverage(s). To be eligible to port coverage, you must have been actively at work on the date employment ended and not retiring. You must complete an application and apply for these options within 31 days of your coverage termination. To obtain an application, Please contact MetLife at 1-877-275-6387, Monday – Friday from 9:00 a.m. to 6:00 p.m. Eastern time, to be connected with a Barnum Financial Professional.
Please reference your group number 235717 or City of Providence when calling.

Voluntary Benefits

VISION BENEFITS – Non-Union

Provided by Davis Vision

Website:  https://davisvision.com/members/

Davis Vision Plan Summary

A comprehensive benefit ensuring low out-of-pocket cost to members and their families.  Convenient Network Locations consisting of a national network of credentialed preferred providers throughout the 50 states.

Freedom of Choice, you will have access to care through either Davis Vision network of independent, private practice doctors or select retail partners.  Value-Added Features includes mail order contact lenses replacement contacts (after initial benefit) through DavisVisionContacts.com.  Mail order service ensures easy, convenient, purchasing online and quick, direct shipping to your door.  Also, Laser Vision Correction discounts of up to 25% off the provider’s Usual and Customary fees or 5% off advertised specials, whichever is lower.

Out-of-Network Benefits

You may receive services from an out-of-network provider, although you will receive the greatest value and maximize your benefit dollars if you select a provider who participates in the network.  If you choose an out-of-network provider, you must pay the provider directly for all charges and then submit a claim for reimbursement.

Davis Vision Reimbursement Form

OPTIONAL LIFE INSURANCE

Available to Police, Fire, School and Non-Union employees

Administered by MetLife

Optional Life Insurance may be elected as a new hire or during Open Enrollment at the employee’s cost (cost is based upon employee’s age and coverage amount requested). An Evidence of Insurability Form will need to be completed if electing more than $200,000 in optional life insurance.

MetLife Enrollment Form

MetLife Beneficiary Designation

MetLife Optional Life Rates and Overview

Portability/Conversion at Termination

You may be eligible to port or convert your basic and your optional life coverage(s). To be eligible to port coverage, you must have been actively at work on the date employment ended and not retiring. You must complete an application and apply for these options within 31 days of your coverage termination. To obtain an application, Please contact MetLife at 1-877-275-6387, Monday – Friday from 9:00 a.m. to 6:00 p.m. Eastern time, to be connected with a Barnum Financial Professional.
Please reference your group number 235717 or City of Providence when calling.

FLEXIBLE SPENDING ACCOUNT (FSA)

Healthcare, Dependent Daycare and Transit – Flexible Spending Account – administered by London Health Administrators. in partnership with Blue Cross and Blue Shield of Rhode Island.

FSA claims for 2024-2025 can be submitted until 7/31/25

Enrollment Form

WELLNESS INCENTIVE PROGRAM

FLU SHOTS

Employees and retirees can receive the flu vaccine at a local pharmacy by presenting their CVS Caremark Card or Blue Cross Blue Shield Card.

COORDINATION OF BENEFITS

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