HEALTH INSURANCE 

The Town of Orange is part of the Hampshire County Group Insurance Trust.

•    FY25 Rate Sheet.pdf
•    FY26 Rate Sheet.pdf
•    Required Docs and Info.pdf
•    How to Find A Doctor PCP ID Flyer.pdf
  • Find a Doctor (PCP ID needed for all HMO Plans)

Health Insurance Forms

•    BCBS Member Enrollment and Change Form.pdf
•    Marital Status Affidavit RVSD 04-2024.pdf
•    NEW Fitness Reimbursement Form - effective 7-1-24.pdf
•    Weight-Loss Reimbursement Form.pdf
•    Childbirth Class Reimbursement Form.pdf
•    Retaining Coverage Disabled Dependent.pdf
•    Subscriber Submit Claim Form.pdf

Health Insurance Plan Information - Effective July 1, 2024 - June 30, 2025

•    Blue Care Elect Preferred PPO - Benefits Summary.pdf
•    Blue Care Elect Preferred PPO - SBC Summary.pdf
•    Understanding a PPO Plan.pdf
•    Network Blue New England HMO - Benefits Summary.pdf
•    Network Blue New England HMO - SBC Summary.pdf
•    Understanding a HMO Plan.pdf
•    CVS Caremark HMO-PPO Prescription Summary.pdf
•    CVS Caremark Mail Order Form for HMO and PPO Plans.pdf
•    CANARX Member Enrollment Package.pdf
•    CANARX Formulary.pdf

Medicare/Medex 2 Supplemental Plan Information - Effective January 1, 2025 - December 31, 2025

Important: If you are approaching 65, you MUST start the Medicare process 3 Months in advance. Please notify the HR office when you have done so. Thank you!

Going to be 65? Please read:

• Medicare Important Notice
• Medicare Handout
•    2025 Medex 2 - Summary of Benefits .pdf
•    2025 Blue Medicare Rx PDP - Summary of Benefits .pdf
•    2025 Blue MedicareRx PDP Enrollment Form.pdf
•    2025 BMRX PDP 3 Tier Drug Formulary Book.pdf
•    BMRX PDP CVS Caremark Mail Service Order Form.pdf

OTHER INSURANCE/BENEFITS

Dental Insurance Forms and Plan Information - Effective July 1, 2024 - June 30, 2025

•    BCBS Dental Enrollment and Change Form.pdf
•    Town of Orange EOC (Explanation of Coverage).pdf

Life Insurance Forms

•    Boston Mutual Enrollment Form.pdf
•    Life Claim Form.pdf

Aflac Information

•    Aflac Website
•    For more information about products, reach out to our rep: Maureen A. Wilczynski 
  • Reach Maureen at  (508) 340-8603   or   maureen_wilczynski@us.aflac.com

RETIREMENT

Franklin Regional Retirement System 

•    FRRS Website
•    Retiree Information
•    Beneficiary Change Form

403(B) and 457(B) - Voluntary and Involuntary Retirement Information

•    Corebridge Website
•    403(B) and 457(B) Enrollment Form
•    403(B) Retirement Savings Plan (Voluntary) Summary
•    457(B) Deferred Compensation Plan (Involuntary) Summary
•    For more information about products, reach out to our rep: Nicholas Nestro 
  • Reach Nick at  (603) 594-8340   or   nicholas.nestro@corebridgefinancial.com