Health Insurance


This is the first year that the new health care law, also called the Affordable Care Act or Obamacare, required employers to send 1095-C forms to certain employees.

If you were a full-time employee working an average of 30 or more hours per week and/ or were enrolled in health insurance through the Town for any time during 2015, you should have received a Form 1095-C.

The Form 1095-C contains important imformation about the health care coverage offered or provided to you by the Town.  

Important Reminders for employees who have their health insurance through the Town.  You are required to notify the Payroll and Benefits Office within 30 days of the following event:

  • Divorce/ Remarriage
  • Medicare eligibility for your self or dependent (whether Medicare is due to age or disability)
  • Marriage
  • Birth of a child
  • Adoption
  • Legal guardianship
  • Dependent loss of status as a dependent
  • Change of address 

FY17 Health & Dental Insurance Rates


Availability of Summary Health Information

As an employee, the health benefits available to you represent a significant component of your compensation package. They also provide important protection for you and your family in the case of illness or injury.

Your plan offers a series of health coverage options. Choosing a health coverage option is an important decision. To help you make an informed choice, your plan makes available a Summary of Benefits and Coverage (SBC), which summarizes important information about any health coverage option in a standard format, to help you compare across options.

Health Insurance Enrollment and Changes Forms (click on links below)  Employees must list a primary care physician and PCP# for their doctors and their dependents if applicable.   Marriage certificates and birth certificates are required for all dependents being covered.

Blue Cross Enrollment and Change Form:

Harvard Pilgrim HMO Enrollment and Change Form:

FY17 Comparison of Benefits (click on links below)

PPO Comparison of Benefits 

HMO Comparison of Benefits 


Blue Cross Enrollment and Change Form

Harvard Pilgrim Enhance Enrollment Form

Comparison of Benefits for Retirees enrolled in Medicare A&B

FY17 Summary of Benefits (click on links below)

Harvard Pilgrim HMO Ratesaver

Harvard Pilgrim Benchmark

Blue Care Elect Rate Saver

Blue Care Elect Benchmark

Network Blue Rate Saver

Network Blue Benchmark

Important Health Insurance Notices

MMHG HIPAA Notice of Privacy Practices

MMHG Creditable Coverage Notice

Notice of Health Insurance Marketplaces

Children's Health Insurance Program (CHIP)

Find A Doctor Links:

Blue Cross Blue Shield Find a Doctor

Harvard Pilgrim Find A Doctor

New Employees

New employees must enroll in health insurance, dental insurance, or life insurance, within 30 days of the hire date in order to participate in any of these plans.   If a new employee is not interested in participating in one or all of these plans, they must sign the form below acknowledging that they are declining enrollment in these plans at this time.

Use link below for denial of coverage form.

Denial of Insurance coverage form:

For additional information information about health insurance and wellness programs visit the Mayflower Municipal Health Group's website at, or their Facebook page at

Employees who enroll in one of the Town's health insurance plans must sign the the notice below, confirming that they will notify the Town about any qualifying life events.

Use link below for employee acknowlegement form.

30 Day Employee Notification Acknowlegement Form

Dental Insurance Information

Flexible Spending Account Information