Employee Benefits

Unemployment Claims Information - click here

Benefit Payments   - click here to pay for benefits


Annual Enrollment for Town of Brookline Employees, Retirees and Survivors

FY2021 Annual open enrollment for benefits ended on JUNE 1, 2020. Benefits Questions?  Other than the annual open enrollment, changes to benefits may only be made for a qualifying event.  Please email Human Resources Benefits with any questions. 

HEALTH INSURANCE

Health Insurance Forms and Information

  1. GIC Benefit Decision Guide Active/Retired (PDF)
  2. Enrollment and Change Form-Active Employees (PDF)
  3. Dependent Age 19-26 GIC Form (PDF)
  4. GIC Retiree Medicare Enroll/Change Form (PDF)
  1. Opt-Out Program Policy (PDF)
  2. Opt-Out Form (PDF)
  3. Health Reimbursement Arrangement (PDF)
  4. HRA Claim Reimbursement Voucher (PDF)

Town of Brookline Group Insurance Rate Sheets

  1. Group Health Insurance Rates - Active/Non Medicare (PDF)
  1. Group Health Insurance Rates - Medicare Retirees (PDF)

DENTAL INSURANCE

Active Employees- Delta Dental

  1. Delta Dental Enrollment Form (PDF)
  2. Delta Dental PPO Plus Premier Low Option (PDF)
  1. Delta Dental PPO Plus Premier High Option (PDF)

Retiree Dental - GIC Metlife Dental Plan

  1. GIC Retiree Dental Form (PDF)
  1. Retiree GIC METLIFE Dental Handbook (PDF)

FLEXIBLE SPENDING PLANS

  1. Flexible Spending Enrollment Form (PDF)
  2. Dependent Care Claim Form (PDF)
  3. Eligible and Ineligible Expenses (PDF)
  1. Flexible Spending Claim Voucher (PDF)
  2. What is Flexible Spending? (PDF)

LIFE INSURANCE

Have you updated your beneficiary recently?  Just complete a new form and return to HR!

  1. Voluntary Life Enrollment Form (PDF)
  2. Basic Life Insurance Beneficiary Update Card (PDF)
  3. Evidence of Insurability Form (PDF)
  1. 2 - HIPPA FORM (Optional Life Insurance)
  2. Life Insurance Information (Basic) (PDF)
  3. Life Insurance Summary (Optional) (PDF)

Deferred Compensation Plans

  1. Deferred Compensation Plan Providers (PDF)
  2. Enrollment / Change Form (PDF)
  1. Plan Document (PDF)
  2. Withdrawal Packet (PDF)

Retirement Plans

  1. ING Withdrawal Request (PDF)