Pre-65 City Retirees
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, 25 Dorrance Street, Room 411, Providence, RI 02903
If you have additional questions, please reach out to the Benefits Office via an email to or phone 401-680-5278.
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 in December and allows you to alter your current health elections for a January 1 effective date.
Benefits Enrollment Form
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
THE UNIFORM SUMMARY OF BENEFITS AND COVERAGE (SBC) IS A LEGALLY REQUIRED HEALTH PLAN DISCLOSURE DOCUMENT
1033 Retirees SBC After 1985 – No Rx
1033 Retirees SBC September 9, 1995 to Present
Water Supply Board Non-Union Retirees SBC
Water Supply Board Non-Bargained Retirees SBC
BLUE CROSS SUMMARIES
1033 Non-Bargained Retirees September 9, 1995 to Present
1033 Non-Bargained Retirees December 2012 to Present
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
PRESCRIPTION BENEFITS
Provided by CVS Caremark
Customer Service: 1-888-790-8070
Website: www.caremark.com
CVS CAREMARK SUMMARIES
1033 Non-Bargained Retirees September 9, 1995 to Present
VISION BENEFITS
Provided by Blue Cross Blue Shield of RI
City/WSB and Non Union Retirees
- One annual routine eye exam per calendar year with co-payment under medical policy
City Non-Union Retirees
- 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
COORDINATION OF BENEFITS
Retiree Coordination of Benefits Form
Coordination of Benefits (COB) is a provision that applies to working retirees who have access to health coverage through their employer. COB shifts the primary cost of healthcare to the employer of the retiree. The retiree is still covered under the City of Providence health plan. The City’s plan acts as the secondary payer and covers the cost of any covered services not paid for by the working retiree’s health plan.
- If the only plan available to you is an HSA, you do not need to enroll (proof/documentation required)