Prior Health Insurance
Health Benefits – Offered through the Amherst Pelham Health Claims Trust (APHCT)The Town offers two types of health plans: a Preferred Provider Organization (PPO) which the Town contributes 75% of the premium and a Health Maintenance Organization (HMO) which the Town contributes 80% of the premium. The balance of the premium is deducted pre-tax from the employee’s paycheck on a biweekly basis.
When can coverage start?
New Hire: If employee’s effective date of hire is prior to the tenth (10th) of the month, coverage will begin on the first (1st) day of the following month (example: hired 1/5 coverage starts 2/1). If effective date of hire is after the tenth (10th) of the month, coverage will begin the first day following the second month of employment (example 1/19 coverage starts 3/1)
Open Enrollment: Held annually in April and changes take effect July 1.
Qualifying Event: Certain “life events” are eligible to make changes to your plan such as: marriage, divorce, birth/adoption of a child, loss of other coverage. The change must be reported within 30 days of the event and with proper documentation. Please contact HR if you have specific questions or to confirm your situation is eligible under a qualifying event.
** Please note it is the employee’s responsibility to notify the Accounting office of any other types of changes such as name change, address change, corrections.
If declining coverage, a waiver of insurance form must be completed and returned to Accounting.
Opt-Out Incentive Program: If you are a current active employee enrolled in the health insurance, there is an incentive if you choose to opt-out of this insurance. You will receive a payment of $1,500 for an individual plan and $3,000 for family per year. You can join this program at any time.
How do I know which plan type is best for me, HMO or PPO?
Employees, Retirees under the age of 65 and Non-medicare eligible retirees:
- Harvard Pilgrim Health Care - Contact info: 888-777-4742 or www.harvardpilgrim.org
Summary of Benefits for HMO
Summary of Benefits for PPO
- Blue Cross Blue Shield – Contact info: 800-486-1136 or www.bluecrossma.com
Summary of Benefits for Network Blue New England HMO & Elect Preferred (PPO)
Network Blue/Elect Preferred Comparison
Retirees with Medicare:
- Harvard Pilgrim Medicare Enhance
- Blue Cross Blue Shield Medex 3
- Medex 2 Effective 1/1/19
- Blue MedicareRX PDP 1/1/19
- Medicare Part D Coverage Determination Form
Prescription Plans(all health plans have prescription drug coverage, below are additional elective plans)
- Harvard Pilgrim Enhance Rx Sheet FY18
- BCBS $9 Prescription Medications
- Amherst Meds Enrollment Form and List of Available Medications