The elections you make as a new hire will remain in place unless you experience a Qualifying Event or make a change during our annual Open Enrollment.
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
OPEN ENROLLMENT
Open Enrollment occurs annually in June and allows you to change your coverages for an effective date of July 1 each year.
Core Benefits
Benefits at a Glance
Benefits Enrollment Form
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MEDICAL BENEFITS
Provided by Blue Cross Blue Shield of Rhode Island
Local – (401) 459-5000
Out of state residents – 1-800-369-2227
Website: www.bcbsri.com
Summary of Benefits and Coverage (SBC)
The SBC is a legally required health plan disclosure document
BLUE CROSS SUMMARIES
Medical Policy: Gender Reassignment Surgery
PRESCRIPTION BENEFITS
Provided by CVS Caremark
Customer Service: 1-888-790-8070
Website: www.caremark.com
CVS CAREMARK SUMMARIES
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CVS CAREMARK SUMMARIES – City and WSB Non-Bargaining
Provided by CVS Caremark (Non-Oral Medications)
Customer Service: 1-888-790-8070
Website: www.caremark.com
Express Scripts for Local 1033 members only (Oral Medications Only)
Customer Service: 1-800-687-0707
Website: www.express-scripts.com
Contact Local 1033 – (401) 331-1033 for information
Summary of Benefits and Coverage (SBC)
A legally required healthcare disclosure document
Local 1033 Express Scripts SBC
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
DELTA DENTAL SUMMARIES
Active Non-Union Introducing: The Maximum Carry Over Provision Flyer
Active Water Non-Union Introducing: The Maximum Carry Over Provision Flyer
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DELTA DENTAL – City and WSB Non-Bargaining
Provided by Delta Dental of RI
Billing – (401) 752-6200
Enrollment – (401) 752-6234
Customer Service – (401) 752-6100
Website: www.deltadentalri.com
Contact Local 1033 – (401) 331-1033 for information
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.
Voluntary Benefits
VISION BENEFITS
Provided by Blue Cross Blue Shield of RI under the medical plan:
- 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
Vision – Hardware
Provided by Davis Vision
Davis Vision Reimbursement Form
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VISION BENEFITS – City and WSB Non-Bargaining
Eye Med Vision Plan for 1033 Members only
Customer Services: 1-866-800-5457
Website: www.eyemed.com
Contact Local 1033 – (401) 331-1033 for information
OPTIONAL LIFE INSURANCE
Available to Police, Fire, School and Non-union employees
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.
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 2020-2021 may be submitted to London Health Administrators until July 30, 2021. After July 30, 2021, your 2020-2021 FSA money will be forfeited.
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
