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Benefit Information - Health and Dental

SUMMARY OF BENEFITS

Town of Milford - Non Union

AFSCME

HEALTH AND DENTAL RATE SHEETS

HEALTH

2024 Health Insurance Rate Sheet

2023 REVISED 4.1.2023 Health Insurance Rate Sheet - FINAL

2022 Health Insurance Rate Sheet - revised 4.1.2022 

DENTAL

2024 Dental  Insurance Rate Sheet

2023 Dental Insurance Rate Sheet - FINAL

2022 Dental insurance Rate Sheet 

MEDICAL - TOWN NON-UNION AND AFSCME

HealthTrust

25 Triangle Park Drive

Concord, NH  03301

Toll free 800-527-5001

www.healthtrustnh.org

PO Box 617

Concord, NH  03302-0617

Type of Plan / Links

About Health Trust (30 min video)

Application  - Use this application if signing up for HealthTrust Medical AND Dental

DENTAL ONLY Application  - Use this application if signing up for DENTAL ONLY

Medical Plan AB15/40 (1K/3K deductible)

Plan Documents

For ACTIVE and COBRA PARTICIPANTS

ACCESS BLUE NEW ENGLAND - 

AB 15/40 IPDED(01L)-R10/25/40M10/40/70/5K(L)

Group Number 362223M010 (new number for Active/COBRA)

2024

Cost Sharing Schedule

Summary of Benefits and Coverage

Subscriber Certificate

RX Benefit Summary

Medical Plan ABSOS (3K/9K deductible)

Plan Documents

For ACTIVE and COBRA PARTICIPANTS

ACCESS BLUE NEW ENGLAND

ABSOS  25/50/3KDED(01L)-R10/25/40M10/40/70/5K(L)

Group Number 362223M014 (new number for Active/COBRA)

2024

Cost Sharing Schedule

Summary of Benefits and Coverage

Subscriber Certificate

RX Benefit Summary

Benefit Comparison

LifeResources - EAP - Employee Assistance Program To contact the LifeResources - Employee Assistance Program call 800.759.8122.

Anthem Participating Primary Care Provider List 2020

Program Materials

Submission Timeframes

Vision - Anthem Vision Discounts

WAIVER Form - Health and Dental - Town and AFSCME

UPDATED EFF 11.28.2023

RETIREES

RETIREES - 65 AND UNDER - PLAN INFORMATION / PLAN DOCUMENTS

Retiree Coverage - UNDER 65 WITHIN NEW ENGLAND AREA

Early Retiree Benefit Packet 2023

UNDER 65 OUTSIDE NEW ENGLAND AREA

2023 / month

Insurance

Single

2 Person

Family

Medical AB15/40

$ 1,017.83

$ 2,035.66

$ 2,748.14

ABSOS

$    692.30

$ 1,384.60

$ 1,869.21

Dental LOW

$     33.39

$    65.33

$    131.73

Dental HIGH

$     51.51

$    99.63

$    181.50

AB15/40 RETIREE UNDER 65 WITHIN NEW ENGLAND AREA

Group Number 362223M011 (new number for Under 65 Retirees)

2024

2023

Cost Sharing Schedule

Summary of Benefits and Coverage

Subscriber Certificate

RX Benefit Summary

SOS RETIREE UNDER 65 WITHIN NEW ENGLAND AREA

Group Number 362223M015 (new number for Under 65 Retirees)

2023

Cost Sharing Schedule

Summary of Benefits and Coverage

Subscriber Certificate

RX Benefit Summary

___________________________________________________________________________________

2023 / month

Plan

Single

2 Person

Family

LUMENOS

$    996.37

$ 1,992.74

$ 2,690.20

RETIREE UNDER 65 and OUTSIDE the NEW ENGLAND AREA

2023

LUMENOS Cost Sharing Schedule

LUMENOS (SBC) Summary of Benefits and Coverage

LUMENOS Subscriber Certificate

__________________________________________________________________________________

RETIREES - 65 AND OVER - PLAN INFORMATION

Retiree Coverage - Over 65

MEDICOMP (Over 65) Retiree Benefit Packet 2023

(per person/per month)

Plan

2022

2023

2023 MEDICOMP THREE - MC3(01L)-R10/25/40M10/40/70(LCY) (includes prescriptions) 

Cost Sharing Schedule

Subscriber Certificate

RX Benefit Summary

2023 MEDICOMP THREE - MCNRX(01L) (Medical only.  Prescription is chosen by retiree from the marketplace)

Cost Sharing Schedule

Subscriber Certificate

NO Prescription

___________________________________________________________________________________

Retiree FORMS

ACH Payment Form

Retiree Medical and/or Dental Application and Change Form

NHRS Annuity Deduction

FLEXIBLE SPENDING ACCOUNT (FSA)

FSA

updated 11.30.23

Flexible Spending Account

FSA Enrollment Form (2024) - fillable

FSA Plan Document (2024)

FSA Brochure Rev 2023

FSA Claim Form Rev 3.2023

FSA Election Worksheet  Rev 2.14.23

FSA Healthcare Eligible Expenses Rev 4.2023

Grace Period - Last day of the Grace Period:  Fifteenth day of the 3rd month following end of the play year. (3/15/xx)  Claims submitted from 1/1 - 3/15 for a prior year should be submitted manually (fax, scan, etc.).

DENTAL - ALL EMPLOYEES

Delta Dental

One Delta Drive

PO Box 2002

Concord, NH  03302

Toll free 800-537-1715

www.nedelta.com/Home

Outline of Benefits - High Option 1O FLX - 3116-5486

Outline of Benefits - Low Option 4 FLX - 3116 - 5490

Dental Plan Document

Dental Plan Description 

Dental FAQ's

Delta Dental EyeMed Discount  - Vision Care Discount

MEDICAL - TEAMSTER'S

CONTRACT SURRENDERED NH LOCAL #633 EFFECTIVE 9/20/23 

ALLEGIANT CARE INSURANCE EXPIRES 10/31/23

Contact Info

Milford NH Town Hall, 1 Union Square, Milford, NH 03055, 603-249-0600 Government Websites by CivicPlus ®