Employees

IMPORTANT INFORMATION REGARDING FORM 1095-C: 

Notice Regarding Form 1095-C

Active Employee Benefit Information and Forms

Employees working over 20 hours per week on a regular basis that are entitled to benefits can review those benefits below. These benefits can be changed during the open enrollment period or when a qualifying life changing event occurs. 

Blue Cross Blue Shield Health Insurance

• Health Enrollment/Change Form 
• Health Insurance Waiver 
• BCBS Plan Options and Resources
• HMO vs. PPO 
• FY26 Insurance Rates 
• Fitness Reimbursement  
• Mind and Body Reimbursement
• Weight-loss Reimbursement
• SmartShopper

Blue Cross Blue Shield Dental Insurance

• Dental Insurance Enrollment/Change Form 
• Summary of Benefits
• Dental Insurance Waiver 

Blue 20/20 Vision

• Vision Enrollment/Change Form 
• Summary of Benefits
• Vision Insurance Waiver 

Boston Mutual Life Insurance

• Enrollment Form/Waiver 
• Voluntary Life Insurance Rates 

Aflac

• Flyer

Employee Assistance Program - EAP

• MIIA EAP Services 
• MIIA EAP Services Packet

Nationwide/OBRA

• 457(b) Deferred Compensation EZ Enrollment Form
• OBRA Enrollment Form
• Name/Address/Beneficiary Change Form
• Purchase of Service Credit Form
• Rollover Request Form
• OBRA Withdrawal Form

Worcester Regional Retirement 

• New Member Enrollment Form 
• Beneficiary Selection Form 
• Notice of Potential Veterans' Benefits 
• Members Transfer Request Form
• Withdrawal of Funds Form

Worker's Compensation

• Supervisor's Accident Report & Medical Authorization Form
• Injured Employee Form for Medical Provider

Additional Information

• Direct Deposit Form
• Change of Address Form
• Name Change Form
• Pre-Tax Election Form 
• Social Security Acknowledgment Form 
• I-9 Form 
• M-4 State Tax 
• 2026 W4 Form 
• FMLA Poster 
• 2026 Observed Holidays 
• Conflict of Interest