Active Employees

Coverage Adjustments

To make a change from your existing coverage to another plan, enroll or cancel coverage for yourself or any of your dependents, or to enroll with the town as a new subscriber please complete the Insurance Company’s Application or Enrollment Form. These forms can be found on this page.

Enrolling Dependents

If you are enrolling a dependent for the first time, you must include:

  • For a spouse or ex-spouse: A copy of their Social Security Card and your city/town issued marriage certificate or your divorce decree.
  • For dependent children under age 26: A copy of their Social Security Card and a birth certificate, adoption, or guardianship papers.

Enrollment Deadlines

All applications and accompanying paperwork must be received by Nicholas Federico, Treasurer/Collector, within 30 days of the qualifying event.

Application / Enrollment Forms

  1. CanaRx Program (PDF)
  2. Diabetes Care Rewards Program (PDF)
  3. Fallon Select and Fallon Direct Enrollment Form (PDF)
  4. Harvard Pilgrim HMO Enrollment Form (PDF)
  5. Harvard Pilgrim PPO Enrollment Form (PDF)
  6. MyTelemedicine Program (PDF)
  7. Tufts Enrollment Form (PDF)