QUALIFYING EVENT
A life event that allows you to make changes to your current health plan
- Qualifying Events include: Marriage/Birth/Adoption/Loss of coverage
- Documentation: Marriage License/Birth Certificate/Adoption papers/ HIPAA letter
*ALL CHANGES MUST BE SUBMITTED WITHIN 30 DAYS OF THE QUALIFYING EVENT WITH THE PROPER DOCUMENTATION
CITY/WATER/POLICE AND FIRE - OPEN ENROLLMENT IS THE MONTH OF MAY
OPEN ENROLLMENT
Open Enrollment occurs annually in May and allows you to change your coverages for an effective date of July 1 each year.
SCHOOL DEPARTMENT - OPEN ENROLLMENT IS THE MONTH OF SEPTEMBER
OPEN ENROLLMENT
Open Enrollment occurs annually in September and allows you to change your coverages for an effective date of October 1 each year.
Have Questions?
City/Water/Police and Fire:
You may contact the City Benefits Office via email to or by calling (401) 680-5279.
You may also forward completed forms and applications to the City Benefits Office via email to ; fax to (401) 680-5457 or Interoffice Mail.
School Department:
Active Employees – You may contact the City Benefits Office via email to or by calling (401) 680-5281
You may also forward completed forms and applications to the City Benefits Office via email to ; fax to (401) 680-5457 or Interoffice Mail.
Retirees – You may contact Evelyn Dennis via email to or by calling (401) 680-5285
You may also forward completed forms and applications to the City Benefits Office via email to ; fax to (401) 680-5457 or Interoffice Mail.
Core Benefits
MEDICAL BENEFITS
Provided by Blue Cross Blue Shield of Rhode Island
Local – (401) 429-2290
Out of state residents – 1-866-987-5857
Website: www.bcbsri.com
We offer comprehensive medical coverage which includes the following (not an exhaustive list):
- One annual routine eye exam per the calendar year with co-payment
- Medical Policy: Gender Reassignment Surgery
PRESCRIPTION BENEFITS
Provided by CVS Caremark
Customer Service: 1-888-790-8070
Website: www.caremark.com
DENTAL BENEFITS
Provided by Delta Dental of RI
Billing – (401) 752-6200
Enrollment – (401) 752-6234
Customer Service – (401) 752-6100
Website: www.deltadentalri.com
BASIC/AD&D LIFE INSURANCE
Administered by Prudential
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 Prudential at 1-800-778-3827. Please provide the contract number – 54180 when calling. If you are using a telecommunications device for the hearing impaired (TDD), please call 1-800-496-1214. Representatives are available to assist you Monday through Friday between 8:00 AM and 8:00 PM Eastern Time.
OPT-OUT OF COVERAGE
Employees may forgo Health Coverage and/or 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.
Please refer to your Group Specific Information at the bottom of this page by clicking the applicable button.
Voluntary Benefits
VISION BENEFITS
Available to City and School Non-Union, Police, Fire and Teachers
Provided by Davis Vision
Website: https://davisvision.com/members/
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, Non-union employees (City and School Department)
Administered by Prudential
https://mybenefits.prudential.com
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.
Prudential Beneficiary Designation
Prudential Optional Life Rates
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 Prudential at 1-800-778-3827. Please provide the contract number – 54180 when calling. If you are using a telecommunications device for the hearing impaired (TDD), please call 1-800-496-1214. Representatives are available to assist you Monday through Friday between 8:00 AM and 8:00 PM Eastern Time.
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 2021-2022 may be submitted to London Health Administrators until June 30, 2022, after that date your FSA money will be forfeited.
IDENTITY AND PRIVACY PROTECTION PLAN FOR ALL EMPLOYEES AND THEIR FAMILIES
Administered by Allstate Identity Protection (InfoArmor)
Website: https://www.infoarmor.com/
InfoArmor is protection that includes 24/7 high-risk activity monitoring and will provide assistance with recovering and restoring your identity should theft or fraud occur! Your identity is made up of more than your Social Security number and credit score. Allstate will also help you look after your online activity, from financial transactions to what you share on social media – so you can protect the trail of data you leave behind.
- Identity monitoring and alters
- Full-service remediation
- Identity theft reimbursement
- iOS and Android app
Enrollment Form – City/Water/Police and Fire
Enrollment Form – School Department
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
Active Coordination of Benefits Form – City/Water/Police and Fire
