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Health Insurance Information and Forms

Summary of Benefits and Coverage for all Health Plans

  • SBC'S For Active Employees of the City of Manchester

Rate Charts and Enrollment Forms

HSA Eligibility Acknowledgment Agreements

HSA Payroll Contribution Forms

Health Insurance Opt-Out Incentive Program Rules & Forms

Cash incentive for eligible City of Manchester employees who waive their right to enroll in the City's Health Insurance plan. 
Annual Enrollment is Required.

Additional Health Benefit Notices, Forms and Information

  • RX Home Delivery 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.
  • 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's Special Offers
    Learn about the many discounts on products and services offered by Anthem. 
  • Anthem's 24/7 Nurse Line
    The 24/7 Nurse Line puts you in touch with a registered nurse who can help you decide how to handle a medical issue. Call 800-544-1901.
  • Anthem 360 Health Program Brochure
    Information on Anthem's Health Programs and Discounts offered to the City of Manchester employees on the Anthem plan.

Away from Home Care Program

  • Away From Home Care Brochure
    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. Read this brochure for an overview of the program.
  • Away From Home Care Participating States Booklet
    This booklet shows the states in the US that participate in Anthem's Away From Home Care program. There are some areas within the participating states that do not offer the program so call Anthem to verify the area you are going to is a participant.

Utilization Reports 

These reports were completed for the City of Manchester by Anthem Blue Cross & Blue Shield. They are in-depth analysis of the medical claims for the City of Manchester.

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