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