Please return completed documents to the Town House Payroll Office

Please click HERE for the information about Open Enrollment. The Deadline is May 30, 2025 at 12:00pm

Employee Information

• Change of Address Form (PDF)
• Direct Deposit Update Form (PDF)

Medical Insurances

Health and Dental Coverage

• Blue Cross Blue Shield Webpage
• HMO Blue New England $250 Deductible Coverages (PDF)
• HMO Blue New England $500 Deductible Coverages (PDF)
• PPO Blue Care Elect $500 Deductible Coverages (PDF)
• Dental Blue Freedom Low Coverages Coverages (PDF)
• Dental Blue Freedom High Coverages Coverage (PDF)
• My Blue APP Information (PDF)
• Health and Dental Enrollment/Change Form (PDF)

Health FSA Cafeteria Plan

• Ameriflex Informational Flyer (PDF)
• Ameriflex Enrollment/Declination Form (PDF)

Retiree's

• 2023 Health Rates (PDF)
• 2024 Health Rates (PDF)
• Medex 2 Coverages (PDF)
• Medicare PPO Blue Freedom with Medicare Rx Advantage (PDF)
• 2023 PDP Rx Enrollment Form (PDF)
• PDP Rx Disenrollment Form (PDF)
• Prescription Claim Form (PDF)
• Rx Mail Order Form (PDF)
• Enrollment/Change Form (PDF)

Vision Coverage

• Blue 20/20 Webpage
• Blue 20/20 Coverages (PDF)
• Blue 20/20 Enrollment/Change Form (PDF)

Health EAP Group: (For all employees)

• Member Portal(Please contact HR for access code and password)
• MEGA Perspectives EAP Overview (PDF)

Additionally Provided Health Benefits

• Fitness Reimbursement Form
• Weight Loss Reimbursement Form
• Mind and Body Reimbursement Form
• Reimbursement Form

Employer Paid Benefits

Employer Paid Insurance Coverages: (For all Full-Time Employees)

• Boston Mutual Basic Life and AD and D Coverages (PDF)
• UNUM Long-Term Disability Coverage (PDF)

Required Retirement

Part-Time: MA Deferred Compensation SMART Plan - OBRA

• OBRA Information Guide (PDF)

Full-Time: Plymouth County Retirement

• PCR Webpage

Optional Retirement

Nationwide Insurance

• Informational Flyer (PDF)
• Indexed Principal Protection Plan Flyer (PDF)
• Enrollment Link

Empower/MA SMART Plan

• Informational Flyer (PDF)
• Re-Enrollment Form (PDF)