- Government
- Departments
- Comptroller
- Employee Benefit Information
Employee Benefit Information
Payroll & Benefit Forms
- Benefits Outline (PDF)
- 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
Please send completed forms to the Comptroller's Office.
- Harvard Pilgrim - HMO (PDF)
- Harvard Pilgrim - PPO (PDF)
- Harvard Pilgrim - Enhanced Medicare (PDF)
- Delta Dental (PDF)
Medical and Dependent Care Flexible Spending Plan
(Medical Expense and Dependent Care Reimbursement)
OPEN ENROLLMENT FOR CALENDAR YEAR 2018: November 2 through November 22, 2017!
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.
- FSA 2018 All Forms and Information Packet (PDF)
- Enrollment Form for NEW Enrollees only (PDF)
- Online Enrollment instructions (PDF) 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.