Pre 65 Fire
Completed benefits forms, along with any supporting dependent documentation, can be sent to the Benefits Office via:
Scan and email to email@example.com
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 firstname.lastname@example.org or phone 401-680-5278.
We will do our best to get back to you as soon as we can.
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 occurs annually in December and allows you to alter your current health elections for a January 1 effective date.
Benefits Enrollment Form
Provided by Blue Cross Blue Shield of Rhode Island
Local – (401) 459-5000
Out of state residents – 1-800-369-2227
THE UNIFORM SUMMARY OF BENEFITS AND COVERAGE (SBC) IS A LEGALLY REQUIRED HEALTH PLAN DISCLOSURE DOCUMENT
BLUE CROSS SUMMARIES
DELTA DENTAL SUMMARIES
Provided by CVS Caremark
Customer Service: 1-888-790-8070
CVS CAREMARK SUMMARIES
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)