Employee Benefits

***Please return completed documents to the Town Treasurer's Office***

Freetown Town Hall

3 N Main Street

Assonet, MA 02702

Employee Information

• Change of Address Form
• Direct Deposit Update Form

Medical Insurances:

Health & Dental Coverage

• Blue Cross Blue Shield Webpage
• Blue Cross Blue Shield HMO Coverages
• Blue Cross Blue Shield PPO Coverages
• FY 2023 Health and Dental Rates
• FY 2024 Health and Dental Rates
• Dental Blue Coverages
• Dental Blue Information
• Health and Dental Enrollment/Change Form

Retirees:

• 2023 Retiree Health Rates
• 2023 MIIA Retiree Enrollment/Change Form
• Medex 2 Benefits
• Managed Blue for Seniors Benefits
• PDP RX Enrollment Form
• PDP RX Disenrollment Form
• Prescription Claim Form
• RX Mail Order Form

Additionally Provided Programs:

• Employee EAP Program
  • EAP Program: FAQ
• Fitness Reimbursement Form
• Weight Loss Reimbursement Form
• Mind and Body Reimbursement Form
• Headspace App Information
• Diabetes Care Rewards Program
• Telehealth Information

Vision Coverage

• Blue 20/20 Webpage
• Blue 20/20 Coverages
• Blue 20/20 Enrollment/Change Form

AFLAC Optional Additional Insurance:

• AFLAC Webpage
• AFLAC Online Enrollment

Life Insurance (Optional)

• Boston Mutual Webpage
• Basic Coverage Summary
• Voluntary Coverage Summary
• Voluntary Coverage Schedule & Cost Exhibit

Required Retirement:

Bristol County Retirement

• Bristol County Retirement Webpage
• Retirement Guides

Optional Retirement:

Nationwide

• Nationwide Webpage
• Nationwide Online Enrollment
• Nationwide Printable Enrollment

MASS SMARTPlan

• MASS SMART Website
• SMARTPlan Online Enrollment
• SMARTPlan Printable Enrollment
• SMARTPlan Added Beneficiary Printable Form
• SMARTPlan Services Agreement
• SMARTPlan Fees for Service