Health Benefits

Enrollment Forms

  1. American Fidelity
  2. BCBS Enrollment Form
  3. Boston Mutual Enrollment Form

2023-2024 Summary of Benefits and Coverage Packets

  1. 2023 Blue Care Elect PPO Summary of Benefits and Coverage
  2. 2023 Blue Care Elect PPO Summary of Benefits
  3. 2023 Network Blue New England HMO Summary of Benefits and Coverage
  4. 2023 Network Blue New England HMO Summary of Benefits
  5. 2023 Access Blue NE Saver Summary of Benefits and Coverage
  6. 2023 Access Blue NE Saver Summary of Benefits
  7. 2023 Dental Blue Program Summary of Benefits

Other

  1. Town of Agawam 2023 Model Notice
  2. Annual Open Enrollment Notice 2023
  3. Insurance Rate Sheet - 2023-2024
  4. BCBS Student Certification Affidavit

Health Reimbursement Arrangement -- Network Blue NE subscribers only

  1. Health Reimbursement Arrangement - Summary of Benefits and Coverage
  2. Health Reimbursement Arrangement Memo 2023-2024
  3. Health Reimbursement Arrangement Claim Form 2023-2024

Miscellaneous Forms

  1. Fitness Reimbursement Form
  2. Weight Loss Reimbursement Form