City of Manchester, NH Official Website

Health & Dental Open Enrollment

Open Enrollment for Health and Dental is
May 7, 2018‐May 18, 2018

Health & dental insurance rates effective July 1, 2018 and enrollment forms are available by clicking on the links below.

Reminder: All forms must be submitted to your payroll clerk no later than Friday May 18, 2018

If you will be enrolling in the Lumenos HDHP with an HSA account, go to the Health Savings Account section for additional forms and information.

Quick Links


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.

Rules and form:  Health Insurance Stipend 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.


Summary of Benefits for all Health Plans

  • AFSCME - 5/1/12
  • Airport Teamsters - 3/6/12
  • IAFF - 3/6/12
  • Library Teamsters - 3/6/12
  • MAFS - 2/21/12
  • MAPS - 2/7/12
  • MPPA - 2/7/12
  • Non-Affiliates - 3/6/12
  • PDSS - 10/15/2013
  • WaterWorks Union - 7/31/13
  • Welfare Teamsters - 6/5/12

Links to Summary of Benefits for employees hired BEFORE the dates listed above:

Links to Summary of Benefits for employees hired AFTER the dates listed above:


Rate Charts and Enrollment Forms

Use this form if your date of hire is PRIOR TO:

  • AFSCME - 5/1/12
  • IAFF - 3/6/12
  • Library Teamsters - 3/6/12
  • MAFS - 2/21/12
  • Non-Affiliates - 3/6/12
  • Welfare Teamsters - 6/5/12

Use this form if you are a Department Head, Alderman or if your date of hire is AFTER:

  • AFSCME - 5/1/12
  • IAFF - 3/6/12
  • Airport Teamsters-3/6/12
  • Library Teamsters - 3/6/12
  • MAFS - 2/21/12
  • MAPS & MPPA 2/7/12
  • Non-Affiliates - 3/6/12
  • PDSS Union- 10/15/13
  • WaterWorks Union-7/31/13
  • Welfare Teamsters - 6/5/12

WaterWorks & PDSS Unions

Use this form if your date of hire is PRIOR TO 7/31/13 for Water Works Union or PRIOR TO 10/15/13 for PDSS Union

Use this form if your date of hire is AFTER 7/31/13 for Water Works Union or AFTER 10/15/13 for PDSS Union


Airport Teamsters

Use this form if your date of hire is PRIOR TO 3/6/12 for Airport Teamsters Union 

Use this form if your date of hire is AFTER 3/6/12 for Airport Teamsters Union


MAPS & MPPA Unions

MAPS & MPPA union employees, use this form if your date of hire is PRIOR TO 2/07/12 

MAPS & MPPA union employees, use this form if your date of hire is AFTER 2/07/12 


School Nurses 

Use this form if you are a school nurse hired PRIOR TO 5/1/12

Use this form if you are a school nurse hired AFTER 5/1/12


Delta Dental Plan Information & Forms (all employees)

SUMMARY OF BENEFITS & COVERAGE

FORMS

All employees except Department Heads, Alderman & School Nurses

For Department Heads and Alderman only

For School Nurses only

You must fill out this form if your child is between the ages of 19-25. In order to be on your dental insurance children between the ages of 19-25 must be full time students.

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