Health Insurance Plan Options

Please be advised that changes to your benefits can only be made during the first 30 days after a qualifying event (birth, death, adoption, marriage, divorce, etc.) or during open enrollment. Newly hired benefit eligible employees have 30 days from their start date to make benefit selections.

FY23 Heath Insurance Rates

Plan Comparison Documents & Pre-Tax Plan Savings Options

FY23 Comparison Chart - ALL PLANS

Benchmark Plan comparison (FSA/HRA eligible)	High Deductible Health Plan (HSA eligible)
FY23 Benchmark Plan Comparison Chart	FY23 HDHP Comparison Chart
Flexible Spending Account (FSA) Information	Health Savings Account (HSA) Information
Health Reimbursement Account (HRA) Info	Winning with an HSA

*FY23 Transition of Care program - eligible applicants are defined as those who are currently receiving a transition allowance and who are actively undergoing treatment for a serious, life threatening medical condition whose primary specialist is not covered in the Blue Cross Blue Shield Network.

**Health Insurance Opt Out Application - to be eligible for the Health Insurance opt out option, employees must have had a Town of Wellesley health insurance plan for two consecutive years prior to opting out.

***Additional Insurance Opt Out form - to be eligible for the Additional Insurance opt out option, employees must have a Town of Wellesley insurance plan and must opt out of both Hospital and Accident insurance and/or dental insurance. Forms must be received by the HR office in Town Hall within 30 days of your initial eligibility date to be eligible for this program.

Blue Cross Blue Shield (BCBS)

Network coverage area includes MA, RI, CT, NH, ME & VT

BCBS Benchmark Plan (FSA/HRA eligible) Network Blue New England Deductible HMO Group Number 00-4053588	BCBS High Deductible Health Plan (HSA eligible) Access Blue New England Saver Group Number 00-4062729
BCBS Benchmark Enrollment Form	BCBS HDHP Enrollment Form
BCBS Benchmark Plan Summary	BCBS High Deductible Plan Summary
CanRx Program	CanRx Program
Blue Cross Prescription Formulary	Blue Cross Prescription Formulary
Good Health Gateway Diabetes Program	Good Health Gateway Diabetes Program
	BCBS Preventative Drug List - medications at co-pay level (deductible does not apply)
BCBS Benchmark Hospital Tiering List	$9 Generic Drug List
Find a Doctor* Tool requires Dr. name, zip code and Network Plan Name = Network Blue New England Deductible HMO Network = Network Blue New England with Hospital Choice Cost Share Feature Member Service #: 800-782-3675 Customer Service #: 800-262-2583	Find a Doctor* Tool requires Dr. name, zip code and Network Plan Name = Access Blue New England Saver Network = HMO Blue New England Member Service #: 800-782-3675 Customer Service #: 800-262-2583
BCBS 24 Hour Nurse Line
A Healthy Me - BCBS extras!	A Healthy Me- BCBS extras!

*When searching the BCBS website for a doctor, be sure to use all the credentials above for the specific plan you are interested in. If your doctor does not appear in the online search tool, please call the customer service number listed above, give the group number of the BCBS option you are interested in and ask the representative to assist you with your doctor search.

Harvard Pilgrim Health Care (HPHC HMO)

Network coverage area includes MA, RI, CT, NH, ME & VT

HPHC Benchmark Plan (FSA/HRA eligible) Group Number 028848-0030	HPHC High Deductible Health Plan (HSA eligible) Group Number 018992-0018
HPHC Benchmark Enrollment Form	HPHC HDHP Enrollment Form
HPHC Benchmark Plan Summary	HPHC High Deductible Plan Summary
CanRx Program	CanRx Program
Good Health Gateway Diabetes Program	Good Health Gateway Diabetes Program
HPHC Hospital Tier Listing	HPHC Preventative Drug List - medications at co-pay level (deductible does not apply)
Find a Doctor - HPHC Plan Type = HMO Plan Category = Tiered/Limited Plans Tiered/Limited Plans = ChoiceNet HMO-2022	Find a Doctor - HPHC Plan Type = HMO Plan Category = Standard Plans Standard Plans = HMO or HMO Open Access

Tufts Health Plan

Network coverage area includes MA, RI, NH and extended service areas in Southern ME, Eastern VT and just over the CT border

Tufts Benchmark Plan (FSA/HRA eligible) Group Number 45843-130		Tufts High Deductible Health Plan (HSA eligible) Group Number 57527-130
Tufts Benchmark Enrollment Form		Tufts HDHP Enrollment Form
Tufts Benchmark Plan Summary		Tufts HDHP Plan Summary
CanRx Program		CanRx Program
Tufts Prescription Formulary		Tufts Prescription Formulary
Good Health Gateway Diabetes Program		Good Health Gateway Diabetes Program
		Tufts Health Plan Preventative Drug List - medications at co-pay level (deductible does not apply)
Find a Doctor - Tufts Benchmark Plan		Find a Doctor - Tufts HDHP
THP Overview	Pharmacy Info	Cost Estimator	Discounts
Acupuncture	Fitness Rewards	Eye Care	CVS Extracare

Fallon Select Care - no longer available after 6/30/2022

Fallon Benchmark Plan (FSA/HRA eligible)	Fallon High Deductible Health Plan (HSA eligible)
Fallon Select Comparison Chart	Fallon Select Comparison Chart
Fallon Health Benchmark Plan Summary	Fallon Health High Deductible Plan Summary
Fallon Select Benchmark Plan Summary	Fallon Select HDHP Plan Summary
Fallon Select Participating Hospitals	Fallon Select Participating Hospitals
Fallon ID Card Mobile App	Fallon ID Card Mobile App
CVS Extra Care Card Savings	CVS Extra Care Card Savings
Naturally Well Alternative Health Care	Naturally Well Alternative Health Care
Right Care, Right Place, Right Time	Right Care, Right Place, Right Time
It Fits Reimbursement	It Fits Reimbursement
Fallon SC Benchmark Enrollment Form	Fallon Select HDHP Enrollment Form
CanRx Program	CanRx Program
Fallon Prescription Formulary	Fallon Prescription Formulary
Good Health Gateway Diabetes Program	Good Health Gateway Diabetes Program
	Fallon Health Preventative Drug List - medications at co-pay level (deductible does not apply)

Fallon Direct Care - no longer available after 6/30/2022

Fallon Direct offers a limited network of providers and hospitals. Please check with your Dr.'s office to make sure they accept Fallon Direct specifically before selecting this plan.

Fallon Benchmark Plan (FSA/HRA eligible)	Fallon High Deductible Health Plan (HSA eligible)
Fallon Health Benchmark Plan Summary	Fallon Health High Deductible Plan Summary
Fallon Direct Benchmark Plan Summary	Fallon Direct HDHP Plan Summary
Fallon Direct Participating Hospitals	Fallon Direct Participating Hospitals
Fallon ID Card Mobile App	Fallon ID Card Mobile App
CVS Extra Care Card Savings	CVS Extra Care Card Savings
Naturally Well Alternative Health Care	Naturally Well Alternative Health Care
Right Care, Right Place, Right Time	Right Care, Right Place, Right Time
It Fits Reimbursement	It Fits Reimbursement
Fallon DC Benchmark Enrollment Form	Fallon Direct HDHP Enrollment Form
CanRx Program	CanRx Program
Fallon Prescription Formulary	Fallon Prescription Formulary
Good Health Gateway Diabetes Program	Good Health Gateway Diabetes Program
	Fallon Health Preventative Drug List - medications at co-pay level (deductible does not apply)

Harvard Pilgrim PPO (HPHC PPO)

HPHC PPO Enrollment Form

HPHC PPO Plan Summary

Mass Health Connector Notice

Health Insurance Plan Options

FY23 Heath Insurance Rates

Plan Comparison Documents & Pre-Tax Plan Savings Options

Network coverage area includes MA, RI, CT, NH, ME & VT

Harvard Pilgrim Health Care (HPHC HMO)

Network coverage area includes MA, RI, CT, NH, ME & VT

Tufts Health Plan

Network coverage area includes MA, RI, NH and extended service areas in Southern ME, Eastern VT and just over the CT border

Fallon Select Care - no longer available after 6/30/2022

Fallon Direct Care - no longer available after 6/30/2022

Harvard Pilgrim PPO (HPHC PPO)

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