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Non-Medicare Eligible Retiree Health Plans

Non-Medicare Eligible Retiree Health Plans

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. If you are new to the plan, please click Qualifying Life Events below to see what documentation is needed to newly enroll.

Questions can be directed to Town of Wellesley Human Resources at (781) 431-1019, ext. 2236 or by emailing benefits@wellesleyma.gov .

All enrollment forms should be sent to Human Resources, via email benefits@wellesleyma.gov, or fax 781-431-8643, or by mail 525 Washington St. Wellesley, MA 02482

Benchmark Plan comparison (HRA eligible)	High Deductible Health Plan
FY26 Benchmark Plan Comparison Chart	FY26 HDHP Comparison Chart
RETIREE Health Reimbursement Account (HRA) Info

Blue Cross Blue Shield

Blue Cross Blue Shield (BCBS)

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

Member Service #: 800-782-3675 Customer Service #: 800-262-2583

BCBS Benchmark Plan (FSA/HRA eligible) Network Blue® $300 Deductible with HCCS Group Number 00-4053588	BCBS High Deductible Health Plan Access Blue New England Saver Group Number 00-4062729
BCBS Benchmark Enrollment Form	BCBS HDHP Enrollment Form
BCBS Benchmark Summary of Benefits and Coverage	BCBS High Deductible Summary of Benefits and Coverage
BCBS Benchmark Plan Summary	BCBS High Deductible Plan Summary
Benefit Description	Benefit Description BCBS Preventative Drug List - medications at co-pay level (deductible does not apply)
Find a Doctor* Tool requires Dr. name, zip code and Network Plan Name = Network Blue New England Deductible HMO Network = HMO Blue New England Network with Hospital Choice Cost Sharing Feature	Find a Doctor* Tool requires Dr. name, zip code and Network Plan Name = Access Blue New England Saver Network = HMO Blue New England

*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.

Limited Network Plans (BCBS)

Network coverage area includes MA ONLY**

**Before selecting this plan, be sure your doctors are covered by using the "Find a Doctor" tool with the credentials specified below

BCBS Benchmark Select Plan (FSA/HRA eligible) Network Blue® Select $300 Deductible with HCCS Group Number 00-4069885	BCBS High Deductible Select Health Plan Network Blue® Select Saver Group Number 00-4070369
BCBS Benchmark Select Enrollment Form	BCBS HDHP Select Enrollment Form
BCBS Benchmark Select Summary of Benefits and Coverage	BCBS High Deductible Select Summary of Benefits and Coverage
BCBS Benchmark Select Plan Summary	BCBS High Deductible Select Plan Summary
Find a Doctor* Tool requires Dr. name, zip code and Network Plan Name = Network Blue New England Deductible HMO Network = HMO Blue Select 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 Select Member Service #: 800-782-3675 Customer Service #: 800-262-2583

All BCBS Plans Include:

Blue Cross Prescription Formulary	Hospital Choice Cost Sharing	Member Portal MyBlue	Mental Health Resources	Fitness Reimbursement
No Cost Generic Medication List Check your RX Cost	Non-Hospital Imaging Centers and Labs - less costly!	Access Your Pharmacy Benefits with MyBlue	BCBS 24 Hour Nurse Line	Weight Loss Reimbursement Form
MAIL SERVICE PHARMACY	Less Expensive ER Alternatives	MyBlue App	Preventive Dental Care for Children	Reimbursement Claim Form

Harvard Pilgrim Health Care

Harvard Pilgrim Health Care (HPHC)

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

PPO network is nationwide

Customer Service: 888-333-4742

HPHC Benchmark Plan (FSA/HRA eligible) The Harvard Pilgrim Best Buy ChoiceNet HMO Group Number 028848-0030	HPHC High Deductible Health Plan The Harvard Pilgrim Best Buy HSA HMO Group Number 018992-0018	HPHC PPO Group Number 033318-0010
HPHC Benchmark Enrollment Form	HPHC HDHP Enrollment Form	HPHC PPO Enrollment Form
HPHC Benchmark Summary of Benefits and Coverage HPHC Benchmark Schedule of Benefits HPHC Medical Coverage and Cost Sharing (benchmark)	HPHC High Deductible Summary of Benefits and Coverage HPHC High Deductible Schedule of Benefits HPHC Preventative Drug List - medications at co-pay level (deductible does not apply)	HPHC PPO Summary of Benefits and Coverage HPHC PPO Schedule of Benefits HPHC Medical Coverage and Cost Sharing (PPO)
Find a Doctor - HPHC Plan Type = HMO Plan Category = Tiered/Limited Plans Tiered/Limited Plans = ChoiceNet HMO Click to enlarge:	Find a Doctor - HPHC Plan Type = HMO Plan Category = Standard Plans Standard Plans = HMO or HMO Open Access Click to enlarge:	Find a Doctor - HPHC Plan Type = PPO Plan Category = Standard Plans Standard Plans = PPO Click to enlarge:

All HPHC Plans Include:

Member Guide	HPHC Hospital Tier Listing	HPHC HMO Out of Area Dependent Coverage	Mental Health Resources
Member Secure Account and Mobile App	Prescription Home Delivery	Telehealth	Fitness Reimbursement
HPHC Rx Lookup Tool