Retirees Insurance

Retirees 65 and over

Summary of Benefits

  1. Chicopee Dental 2018
  2. 2020 HNE HMO MEDICARE SECURE SBC Overview chart
  3. 2020_enrollment kit HNE HMO MEDICARE SECURE
  4. 2020 BCBS Medicare HMO Blue
  5. 2020 MANAGED BLUE FOR SENIORS SBC
  6. 2020 BCBS Medex 2 SBC
  7. 2020 BlueMedRx Summary of Benefits
  8. 1-1-2021 Medicare HMO Blue summary plan description
  9. 1-1-2021 managed blue for seniors summary plan description
  10. 1-1-2021 medex summary plan description
  11. 1-1-2021 medex rx summary plan description
  12. HNE Advantage eff 1-1-2021-First Line Essentials Flyer
  13. 1-1-2021 HNE MEDICARE SECURE ADVANTAGE PLAN
  14. retiree comparison chart 6-15-21

Enrollment and Cancellation forms

  1. BCBS Medex/ Managed Blue Enrollment and Termination Form
  2. HNE Medicare Advantage Disenrollment Form 2017
  3. HNE MEDICARE ADVANTAGE ENROLLMENT FORM
  4. Blue MedicareRX 2020 Enrollment Form
  5. 1-1-2021 medex rx enrollment form
  6. 3-1-2021 retiree life election form

Over 65 Rates

  1. 2019 Rates - Retirees 65
  2. 2020 RETIREE 65 INSURANCE RATES
  3. Retiree 65 rates 1-1-2021

Blue MedRX Drug List

  1. Blue MedicareRX Drug List
  2. 2020 MedexRX formulary changes
  3. 2020 Formulary (PDP) Medex RX

OPEN ENROLLMENT RETIREES 65+

  1. 2020 Open Enrollment Ltr - Retiree 65
  2. POSTER OE - 65
  3. 1-1-2021 Open Enrollment Ltr - Retiree 65

Medicare Forms

  1. Medicare - CMS40B - Application for enrollment in Part B
  2. Medicare form CMS-L564 Employment information
  3. HNE Advantage eff 1-1-2021-First Line Essentials Flyer.pdf

Retirees Under 65

Summary of Benefits

  1. FY 2020 BCBS HMO BLUE NEW ENGLAND 3000 SBC
  2. FY 2020 BCBS HMO NEW ENGLAND 3000
  3. FY 2020 BCBS HMO BLUE NEW ENGLAND OPTIONS SBC
  4. FY 2020 BCBS HMO BLUE NEW ENGLAND OPTIONS
  5. HNE PPO 3000 FY2020
  6. HNE HMO ESS 3000 FY2020
  7. HNE WISE MAX FY 2020
  8. FY 2021 HNE PPO 4000
  9. FY 2021 HNE HMO ESSENTIAL 4000
  10. FY 2021 HNE WISE MAX
  11. FY2021 - BCBS NEW ENGLAND OPTIONS
  12. FY 2021 Dental Blue
  13. FY2021 HMO BLUE NEW ENGLAND 3000
  14. FY2021 HMO Blue Options SBC
  15. FY2021 HMO BLUE NEW ENGLAND 3000 SBC

Enrollment and Cancellation forms

  1. Active Employee BCBS Enrollment and Cancellation Form (PDF)
  2. Active Employee HNE Enrollment and Cancellation Form (PDF)
  3. FY 2021 BCBSMA Enrollment - Change Form

Under 65 Rates

  1. Under 65 Health Insurance Rates FY 2018
  2. 2019 OE Notice to Active EE
  3. FY2020 Rate sheet active employees
  4. FY 2022 Benefit Rates

Important Notice about Prescription Coverage and Medicare

  1. IMPORTANT NOTICE ABOUT RX AND MEDICARE

MERP - HNE/BCBS/FAQ'S

  1. FY 2021 City of Chicopee MERP SBC BCBS Plan
  2. FY 2021 City of Chicopee MERP SBC HNE Plans
  3. FY 2021 MERP FAQ

FY 2021 PLAN CHANGES

  1. PLAN CHANGES SPREADSHEET EFF 7-1-20

UNDER 65 OPEN ENROLLMENT NOTICE

  1. FY 2021 OPEN ENROLLMENT LETTER UNDER 65