Welcome to the City of Manchester, NH Official Web Site Register     Login   
   seal

 
Quick Links:    Home | Recreation | Business | Online Payment | Jobs | Meeting Agendas | City Calendars | Contact Us | Site Search
You are here:    Departments » Human Resources » Retirees
Site Navigation

This web site and its contents are a service of the City of Manchester, NH

seal
  Retirees Minimize
 
 


 

_________________________________

Anthem Medicare Preferred (PPO) Group Plan
(This is the only plan available for Retirees Over 65)
This plan is guaranteed until 12/31/2012.

This plan is a Medicare Advantage plan with Part D Prescription Coverage. You need only show your Anthem card - you do not need to show your medicare card.

Click Here for Anthem Medicare Preferred (PPO) Plan Information and Forms

_________________________________
 
Reports & Updates

_________________________________
Effective 7/1/2011 preventative care is covered at 100% for all Health Plans
(see flyer below for services that fall under preventative care)
Preventative Care Flyer

 Anthem High Deductible Health Plan (with optional HSA) (under 65)

As a retiree, you can choose whichever bank you want for your Health Savings Account. If you are interested in opening your Health Savings Account with Citizens Bank, the bank the City of Manchester utilizes for our employees Health Savings Accounts, please contact the Benefits Coordinators, Jane or Sue at (603) 624-6543 and request a Citizens Bank Enrollment Guide.

Maximums/limits and deductibles for HDHP is on a Plan Year Basis (July 1-June 30)

Anthem Summary of Benefits Booklets for HMO; POS; PPO (under 65)

Maximums/limits for the regular HMO and POS plans are on a Calendar Year Basis      (Jan 1-Dec 31)

 ___________________________________
last changed 2/21/2012

 

  Retiree Under 65 Forms Minimize
 
 
 TitleModified DateSize Description
7/1/2011-6/30/2012 Health & Dental Rate Schedule1/20/20128.64 KBDownloadInsurance Rate Chart for FY2012
Anthem Disabled Dependant Form8/2/201074.65 KBDownloadComplete this form if you want to apply for coverage of your disabled dependent who is over maximum age
Anthem Enrollment/Change Form7/2/20111.13 MBDownloadComplete this form to make any changes to your health insurance. If you are cancelling your health insurance, you must also complete the Health Insurance Cancellation Form
Anthem Individual Authorization Form8/2/201076.90 KBDownloadComplete 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 Preventative Care VS Diagnostic Care10/14/2011188.67 KBDownloadPreventative care in now covered at 100% for all plans. This brochure explains the difference between Preventative and Diagnostic Care.
Anthem Telephone Promp "Cheat Sheet"4/11/201159.63 KBDownloadUse this "cheat sheet" if you need assistance working your way through the telephone prompts when you call Anthem
Anthem Vision and Medical Reimbursement Form8/2/201046.05 KBDownloadUse this form to request reimbursement for Vision and Medical expenses paid out of pocket
Anthem's 360 Health Program Brochure2/24/2011678.56 KBDownloadInformation on Anthem's Health Programs and Discounts offered for Retirees on Anthem's health insurance plan
Away From Home Care Program11/13/2010482.30 KBDownloadAs 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 Letter & Application Form11/13/201073.21 KBDownloadDetailed description of the Away From Home program and application form including phone number and mailing address
Delta Dental Enrollment/Change Form7/2/2011437.99 KBDownloadComplete this form to make any changes to your dental insurance
Delta Dental Outline of Benefits8/2/201013.82 KBDownloadBrief outline of your Dental Benefits
Delta Dental Plan Booklet8/2/2010217.56 KBDownloadDetailed booklet explaining your dental coverage; what is covered and at what percentage it is covered, etc
Delta Dental Provider Directory9/16/2011895.00 KBDownloadA directory of participating Delta Dental Dentists
Express Script Prescription Mail Order Form1/18/201192.65 KBDownloadUse 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 Mail Order Pharmacy FAQ1/19/201173.71 KBDownloadThis "toolkit" provides answers to frequently asked questions regarding Anthem's Mail Order Pharmacy; how to reach them; how to set up Home Delivery Services; etc.
Express Scripts Prescription Drug Claim Form1/18/2011232.38 KBDownloadUse this form if you paid for a prescription out of pocket and need to request reimbursement
Fitness Log Card5/7/201062.57 KBDownloadYou can use this log card/or a computer generated one from your fitness center
Fitness Program Overview for HMO & POS plans7/18/2011158.96 KBDownloadRules, guidelines, & instructions for fitness reimbursement. This is ONLY for the regular HMO and POS plans. Fitness Reimbursement for these plans are on a Calendar Year Basis (Jan 1-Dec 31).
Fitness Program Overview for HMO-2; POS-2 and HDPH7/18/2011286.26 KBDownloadRules, guidelines, & instructions for fitness reimbursement. This is ONLY for the HMO-2, POS-2 and HDHP plans. Fitness Reimbursement for these plans are on a Plan Year Basis (July 1-June 30).
Fitness Reimbursement Form5/7/2010439.85 KBDownloadForm required to request fitness reimbursement
Health & Dental Insurance Cancellation Form11/12/201092.50 KBDownloadIf you are cancelling your health and/or Dental insurance, you must fill out an Anthem and/or Delta Dental Enrollment/Change form and this form
NH Retirement Annuity Deduction Authorization Form4/20/201134.49 KBDownloadFire & Police retirees, you must complete this form if you are making any changes that affect your insurance premiums
NHRS Retiree Insurance Rate Chart9/16/20117.70 KBDownloadFire & Police retirees FY2012 Rate Schedule including NHRS Subsidy Amounts
Vision Reimbursement Breakdown8/2/201089.00 KBDownloadBreakdown of Vision Benefits

 

  Updates Minimize
 
 

Health Care Reform Update of 03/31/2010

Following are 2 notices from Medicare for our over 65 retirees (10/4/10):
Medicare and the New Health Care Law
Closing the Prescripton Drug Coverage Gap
last changed 1/20/2012

 

  Contacts Minimize
 
 

Benefits Coordinators: 
Jane LaPerle/Susan Figg
City of Manchester
HR Dept./Benefits
One City Hall Plaza
Manchester, NH  03101
Phone (603) 624-6543
Fax     (603) 628-6065
Email: benefitscoordinator@manchesternh.gov

Contributory Retirement System
Phone (603) 624-6506
Fax (603) 624-6342
Email Address:
gfleury@manchesterretirement.org
Web Site: www.manchesterretirement.org

New Hampshire Retirement System
Phone (603) 410-3500
Toll Free (877) 600-0158
Fax (603) 410-3501
Email: info@nhrs.org
Web site: www.nhrs.org

Citizens Bank (HSA accounts)
Customer Service: (888) 784-4584
lost/stolen card call # above & select Option 2
http://employee.citizensbankhsa.com

To Mail in your HSA Deposits:
Citizens Bank
Health Savings Account
P.O. Box 981012
Boston, MA 02298-1012
(Note: you cannot deposit money into your HSA thru your local Citizens Bank, it can be done by sending a check to the address above)

Anthem Blue Cross & Blue Shield
3000 Goffs Falls Rd
Manchester, NH 03111-0001
Customer Service/Lost card phone (800) 238-2465
Fax #: (603) 695-7067
www.anthem.com

Away from Home Care
Offered for HMO members thru Anthem
Phone (800) 870-3122

Mail Order Pharmacy (Anthem plan)
Express Scripts
Home Delivery Service
P.O. Box 66558
St. Louis, MO  63166-6558
For refills or new prescriptions phone: (866) 281-4279
Doctor can Fax prescriptions to: (866) 272-8856
www.anthem.com (there is a link that will bring you to Express Scripts after you sign on)

Northeast Delta Dental Plan
One Delta Drive
P.O. Box 2002
Concord, NH  03302-2002
Customer Service/Lost Card phone: (603) 223-1234
Claim Issues Customer Service phone: (800) 832-5700

Compass SmartShopper Program
Phone (800) 824-9127
M-F 8:30 a.m to 5:00 p.m
www.mycompassadvisers.com

 

 
last changed 11/17/2010

 


Copyright 2012 City of Manchester    Terms Of Use   Privacy Statement   Site Map