Employee Benefits

Benefits Questions? Please email Human Resources Benefits.

Annual Enrollment for Town of Brookline Employees, Retirees and Survivors

FY2020 Annual open enrollment for benefits will be APRIL 3, 2019 to MAY 1, 2019. Open enrollment is the opportunity for employees and retirees/survivors to review health insurance benefit options and make changes if they choose. This is also the time to review other benefits such as life insurance, dental insurance and to enroll or re-enroll in flexible spending. Changes made during open enrollment become effective on July 1, 2019.  Watch for more information coming soon!

If you are satisfied with your current health insurance plan, you do not need to take any action at open enrollment. Your coverage will continue automatically. However, changes must be done within the open enrollment period. Active employees who wish to enroll in the Flexible Spending Account must submit a form to participate in the next plan year.

Health Insurance Forms

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)
  5. Opt-Out Program Policy (PDF)
  1. Opt-Out Form (PDF)
  2. Health Reimbursement Arrangement (PDF)
  3. Premium Conversion Plan Election Form (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 Forms

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)

Life Insurance Forms

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

  1. Basic Life Insurance Beneficiary Update Card (PDF)
  2. Evidence of Insurability Form (PDF)
  3. Life Insurance Brochure (PDF)
  1. Life Insurance Information (PDF)
  2. Voluntary Life Enrollment Form (PDF)

Flexible Spending

  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)

Premium Conversion Plan

  1. Premium Conversion Plan Election Form (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)