Health & Dental Contributory Retirement Rate Chart
Health and Dental Insurance rate chart for Contributory Retirement retirees. The chart does not include Contributory Retirement Subsidy amounts.
Health & Dental New Hampshire Retirement Rate Schedule
Insurance Rate Chart for New Hampshire Fire and Police Retirees. This chart includes the State subsidy amounts.
Anthem Preventative Care vs Diagnostic Care
Preventative care in now covered at 100% for all plans. This brochure explains the difference between Preventative and Diagnostic Care.
Anthem Preventive Care Brochure effective 7/1/2013
This brochure shows you what is considered preventive care and covered at 100%.
Away From Home Care Program
As a Blue Cross Blue Shield Plan HMO member, Away From Home Care provides healthcare coverage while you are away from your home, such as a child going to college out of state or if you go south for the winter. Read this brochure for more info.
Away From Home Care Participating States
This brochure tells you which states participate in the Away From Home Care program. Click on the state you are going to and it will tell you if that states participates.
Home Delivery Pharmacy Brochure
This brochure provides answers to frequently asked questions regarding Anthem's Mail Order Pharmacy; how to reach them; how to set up Home Delivery Services; etc.
The GenericSelect Program lets you try a generic option on Anthem's list and get that first prescription at no cost.
Price a Drug Brochure
Anthem's tips on how to shop for the best price on your medication.
Urgent Care Brochure
List of Walk-in centers and urgent care centers near you.
Anthem's 360 Health Program Brochure
Information on Anthem's Health Programs and Discounts offered for Retirees on Anthem's health insurance plan.
Anthem's Special Offers
Learn about the many discounts on products and services offered by Anthem.
Anthem Telephone Prompt "Cheat Sheet"
Use this "cheat sheet" if you need assistance working your way through the telephone prompts when you call Anthem.
Health Insurance Enrollment/Change Form
Complete this form to make any changes to your health insurance. If you are cancelling your health insurance, you must also complete the Health and Dental Insurance Cancellation Form.
Health & Dental Insurance Cancellation Form
If you are cancelling your health and/or Dental insurance, you must fill out a Health and/or Dental Enrollment/Change form and this form.
New Hampshire Annuity Deduction Authorization Form
Fire & Police retirees, you must complete this form if you are making any changes that affect your health and/or your Dental insurance premiums.
Anthem Vision and Medical Reimbursement Form
Use this form to request reimbursement for Vision and Medical expenses paid out of pocket.
Express Scripts Prescription Mail Order Form
Use this form to request prescriptions by mail. The easiest and quickest method is to have your doctor fax it in for you. This information is on the form.
Express Scripts Prescription Drug Claim Form
Use this form if you paid for a prescription out of pocket and need to request reimbursement.
Anthem Individual Authorization Form
Complete this form if you want to allow someone else to be able to make inquires on your behalf regarding your Anthem Health Care concerns and claims.
Anthem Disabled Dependent Form
Complete this form if you want to apply for coverage of your disabled dependent who is over maximum age.
Away from Home Letter & Application Form
Detailed description of the Away From Home program and application form including phone number and mailing address.
If you are enrolling in the High Deductible Health Plan, or are already enrolled, and want to open a Citizens Health Savings Account print this packet and follow the instructions listed in the packet.