Home » Departments » Human Resources » Employee Benefits » Health Insurance » Plan Info and Forms

Health Insurance Information and Forms

Summary of Benefits and Coverage for all Health Plans

Rate Charts and Enrollment Forms

FY 2023 Rate Chart

FY 2024 Rate Chart

Health Insurance Opt-Out Incentive Program Rules 

The Health Insurance Opt-Out Incentive program offers a cash incentive to eligible City of Manchester employees who decline enrollment in the City's health insurance. Annual Enrollment is Required.

FY2024 Opt Out Attestation Form


Additional Health Benefit Notices, Forms and Information

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.

Back to Menu