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 or by phone 680-5281.
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 – Teachers
Option Form – Teachers Hired Before Aug. 30, 2004
Option Form – Teachers Hired After Aug. 30, 2004
Benefits at a Glance – LTSP’s
Option Form – LTSP’s Hired Before Aug. 30, 2004
Option Form – LTSP’s Hired After Aug. 30, 2004
Benefits Enrollment Form
Adding Domestic Partnership
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 Teachers No Deductible Plan SBC
Active Teachers $750 Deductible Plan SBC
BLUE CROSS SUMMARIES
Active Teachers No Deductible Plan
Active Teachers $750 Deductible Plan
Teachers No Deductible Plan and $750 Deductible Plan Comparison
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
DELTA DENTAL SUMMARY
PRESCRIPTION BENEFITS
Provided by CVS Caremark
Customer Service: 1-888-790-8070
Website: www.caremark.com
CVS CAREMARK SUMMARIES
Active Teachers No Deductible Plan
Active Teachers $750 Deductible Plan
VISION BENEFITS
No Deductible Plan
Provided by Blue Cross Blue Shield of RI
- One annual routine eye exam per the calendar year with co-payment under the medical policy
Classic Blue and $750 Deductible Plan
- One annual routine eye exam per the calendar year with co-payment under the 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
BCBSRI Vision Reimbursement Form
Voluntary Benefits
VISION BENEFITS
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
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
TEACHERS – ALLSTATE
Short Term Disability, Long Term Disability, Critical Care, Cancer
Contact the Teacher’s Union 401-421-4014
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 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 $200 per employee (or $400 for employee and spouse, or single-parent families) payable in September 2022.
Virgin Pulse Registration Instructions
Doctors Online (Telemedicine) Frequently Asked Questions
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
