Retirees Insurance

Retirees 65 and over

Summary of Benefits

  1. 1-1-2021 Medicare HMO Blue summary plan description
  2. 1-1-2021 managed blue for seniors summary plan description
  3. 1-1-2021 medex summary plan description
  4. 1-1-2021 medex rx summary plan description
  5. HNE Advantage eff 1-1-2021-First Line Essentials Flyer
  6. 1-1-2021 HNE MEDICARE SECURE ADVANTAGE PLAN
  7. retiree comparison chart 6-15-21
  8. 2022 BCBS Medex 2 Summary
  9. 2022 BCBS Managed Blue Seniors Summary
  10. 2022 BCBS BlueMedRx Summary
  11. HNE EGWP_Plan_Overview_Chart_

Enrollment and Cancellation forms

  1. BCBS Medex/ Managed Blue Enrollment and Termination Form
  2. HNE Medicare Advantage Disenrollment Form
  3. HNE MEDICARE ADVANTAGE ENROLLMENT FORM
  4. Standard Retiree Life Election Form
  5. 2022 BCBS Blue Medicare RX Enrollment
  6. HNE Enrollment_Fom
  7. 1-1-2022 Open Enrollment Ltr - Retiree 65 (2)

Over 65 Rates

Blue MedRX Drug List

  1. Blue MedicareRX Drug List
  2. 2022 BCBS Tier 3 Formulary
  3. 2022 BCBS Blue MedicareRx (PDP) Formulary Changes Drug

OPEN ENROLLMENT RETIREES 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 2021 HNE PPO 4000
  2. FY 2021 HNE HMO ESSENTIAL 4000
  3. FY 2021 HNE WISE MAX
  4. FY2021 - BCBS NEW ENGLAND OPTIONS
  5. FY 2021 Dental Blue
  6. FY2021 HMO BLUE NEW ENGLAND 3000
  7. FY2021 HMO Blue Options SBC
  8. 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. 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

UNDER 65 OPEN ENROLLMENT NOTICE

  1. FY 2021 OPEN ENROLLMENT LETTER UNDER 65