City of Manchester, NH Official Website

Health Insurance Information and Forms

Below are quick links to get you to the correct section that will have your health insurance rate information and forms. Click on the link that coincides with your Affiliation:

Click on the links below for more information on the following:


Summary of Benefits and Coverage for all Health Plans

The purpose of the Summary of Benefits and Coverage (SBC) is to provide individuals with standard information so they can compare medical plans as they make decisions about which plans to choose. 

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Rate Charts and Enrollment Forms

Airport

AFSCME and School Nurses

IAFF and MAFS 

Library Teamsters

MAPS and MPPA

Non Affiliated

PDSS 

USWA Water Union

Welfare Teamsters


Health Insurance Opt-Out Incentive Program Rules & Forms

This program offers a cash incentive to eligible City of Manchester employees who waive their right to enroll in the City's Health Insurance plan.

See below for rules and form:

IMPORTANT:
You must re-apply for the incentive each fiscal year! If you applied and received the incentive last year, you will not automatically get it again this fiscal year - you must re-apply for it.

If you are currently on the City's health insurance, you must also complete the Health Insurance Enrollment/Change form to cancel your health Insurance. 

The Incentive is considered ordinary income and therefore subject to Federal, State, Social Security, and Medicare taxes and City and State Retirement deductions.

Additional Health Benefit Information and Forms

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.

Other Forms

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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