Active School 1033 Benefits
Completed benefits forms, along with any supporting dependent documentation, can be sent to the Benefits Office via:
Fax to 401-680-5457
Mail to Benefits Office Attn: Active School, PO Box 1656, Providence, RI 02901
If you have additional questions, please reach out to the Benefits Office via an email to . We will do our best to get back to you as soon as we can.
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 and allows you to alter your current health plan
- School Open Enrollment - September 1-30 for an effective date of October 1.
FSA OPEN ENROLLMENT IS THE MONTH OF MAY
- Flexible Spending Account (FSA) Open Enrollment occurs annually in May for an effective date of July 1.
Core Benefits
Benefits at a Glance - 12 Month BEST
Benefits at a Glance - 10 Month BEST
Benefits at a Glance - TA's & Bus Monitors
Benefits at a Glance - Crossing Guards
Benefits Enrollment Form
Adding Common Law Spouse
Affidavit of Common Law Spouse
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
THE UNIFORM SUMMARY OF BENEFITS AND COVERAGE (SBC) IS A LEGALLY REQUIRED HEALTH PLAN DISCLOSURE DOCUMENT
Active School 1033 Safety/Bus Monitors, Teacher Assistants and Crossing Guards SBC
BLUE CROSS SUMMARIES
Active School 1033 Safety/Bus Monitors, Teacher Assistant and Crossing Guards
HRA Benefit Grids
HIPPA
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
Contact Local 1033 - (401) 331-1033 for information
PRESCRIPTION BENEFITS
Provided by CVS Caremark (Non-Oral Medications)
Customer Service: 1-888-790-8070
Website: www.caremark.com
CVS Caremark Summaries (Non-Oral Medications)
Active School 1033 Safety/Bus Monitors and Teacher Assistants
Provided by Express Scripts for Local 1033 members only (Oral Medications Only)
Customer Service: 1-855-525-8001
Website: www.express-scripts.com
Contact Local 1033 - (401) 331-1033 for information
THE UNIFORM SUMMARY OF BENEFITS AND COVERAGE (SBC) IS A LEGALLY REQUIRED HEALTH PLAN DISCLOSURE DOCUMENT
Local 1033 Express Scripts SBC
VISION BENEFITS
EyeMed Vision Plan for 1033 Members only
Customer Service: 1-886-800-5457
Website: www.eyemed.com
Contact Local 1033 - (401) 331-1033 for information
Voluntary Benefits
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. Extended Grace period through June 30, 2022 to use current year contributions
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.
Wellness Incentive Program
The City of Providence Local Union 1033 Wellness Incentive Program is designed to reward eligible BCBSRI members who adopt and maintain a healthy lifestyle and to assist them in achieving healthy living milestones. Eligible union members who complete designated wellness requirements and activities between July 1, 2021 and June 30, 2022 can earn up $300 per employee (or $600 for employee and spouse, or single-parent families) payable in September 2022.
Employees who do not receive their annual well visit (physical) with their Primary Care Physician (PCP) between July 1, 2021 and June 30, 2022 will be 1% more in their annual co-shares beginning July 1, 2023.
Local Union 1033 Wellness Incentive Program
Virgin Pulse Registration Instructions
Doctors Online (Telemedicine) Frequently Asked Questions
Local Union 1033 Wellness Incentive Program Frequently Asked Questions
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
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