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- Departments
- Human Resources Department
- Employee Benefit Information
Employee Benefit Information
Payroll & Benefit Forms
- Benefits Summary
- Direct Deposit Form (ACH Credits) (PDF)
- Employee Assistance Program (PDF)
- Health Insurance Responsibility Disclosure (HIRD) (PDF)
- Health Reimbursement Arrangement Request Form (PDF)
- HIPAA Privacy Notice (PDF)
- Payroll Tax Withholding Form - Federal (Form W-4) (PDF)
- Payroll Withholding Form - State (M-4) (PDF)
- Town Wellness Incentive Benefit Election Form (PDF)
Insurance Links
Insurance Rates
Insurance Enrollment/Change Forms
- Blue Cross Blue Shield Enrollment Form
- Blue Cross Blue Shield Medicare Supplemental Plan Enrollment Form
- Delta Dental (PDF)
Retiree Medicare Supplemental Plans
- Blue Cross Blue Shield MedEx 2 Summary of Benefits
- Blue Cross Blue Shield Managed Blue for Seniors (MBFS) Summary of Benefits
- Blue Medicare RX (PDP)
Medical and Dependent Care Flexible Spending Plan & Reimbursement
Information and enrollment forms for the Town’s Flexible Spending Plans can be found by clicking the links below. If you have questions or need additional information, please call the Human Resources office.
- Flexible Spending Benefits & Enrollment Form for new hires
- Online Enrollment instructions for current participants
The Town’s flex spending plan is managed by Cafeteria Plan Advisors. Please visit their website for reimbursement forms and current information about the plan.