Completed benefits forms, along with any supporting dependent documentation, can be sent to the Benefits Office via:

Scan and email to benefits@ppsd.org

Fax to 401-680-5457

Mail to Benefits Office Attn: Active School, PO Box 1656, Providence, RI 02901

If you have additional questions, please reach out to the Benefits Office via an email to benefits@ppsd.org or by phone 680-5281. 

We will do our best to get back to you as soon as we can.

QUALIFYING EVENT

A life event that allows you to make changes to your current health plan

Blue Cross Reimbursement Form

Voluntary Benefits

VISION BENEFITS

Provided by Davis Vision

Website:  https://davisvision.com/members/

Davis Vision Plan Summary

A comprehensive benefit ensuring low out-of-pocket cost to members and their families.  Convenient Network Locations consisting of a national network of credentialed preferred providers throughout the 50 states.

Freedom of Choice, you will have access to care through either Davis Vision network of independent, private practice doctors or select retail partners.  Value-Added Features includes mail order contact lenses replacement contacts (after initial benefit) through DavisVisionContacts.com.  Mail order service ensures easy, convenient, purchasing online and quick, direct shipping to your door.  Also, Laser Vision Correction discounts of up to 25% off the provider’s Usual and Customary fees or 5% off advertised specials, whichever is lower.

Out-of-Network Benefits

You may receive services from an out-of-network provider, although you will receive the greatest value and maximize your benefit dollars if you select a provider who participates in the network.  If you choose an out-of-network provider, you must pay the provider directly for all charges and then submit a claim for reimbursement.

Davis Vision Reimbursement Form

OPTIONAL LIFE INSURANCE

Administered by Prudential

https://mybenefits.prudential.com

Optional Life Insurance may be elected as a new hire or during Open Enrollment at the employee's cost (cost is based upon employee's age and coverage amount requested). An Evidence of Insurability Form will need to be completed if electing more than $200,000 in optional life insurance.

Prudential Enrollment Form

Prudential Beneficiary Designation

Prudential Optional Life Rates

Portability/Conversion at Termination

You may be eligible to port or convert your basic and your optional life coverage(s). To be eligible to port coverage, you must have been actively at work on the date employment ended and not retiring. You must complete an application and apply for these options within 31 days of your coverage termination. To obtain an application, please contact Prudential at 1-800-778-3827. Please provide the contract number - 54180 when calling. If you are using a telecommunications device for the hearing impaired (TDD), please call 1-800-496-1214. Representatives are available to assist you Monday through Friday between 8:00 AM and 8:00 PM Eastern Time.

FLEXIBLE SPENDING ACCOUNT (FSA)

Healthcare, Dependent Daycare and Transit - Flexible Spending Account - administered by London Health Administrators. in partnership with Blue Cross and Blue Shield of Rhode Island.

FSA claims for 2020-2021.  Extended Grace period through June 30, 2022 to use current year contributions

Enrollment Form

FSA Member Guide

FLU SHOTS

Employees and retirees can receive the flu vaccine at a local pharmacy by presenting their CVS Caremark Card or Blue Cross Blue Shield Card.

Wellness Incentive Program

The City of Providence Wellness Incentive Program is designed to reward eligible BCBSRI members who adopt and maintain a healthy lifestyle and to assist them in achieving healthy living milestones. Eligible members who complete designated wellness requirements and activities between July 1, 2021 and June 30, 2022 can earn up $300 per employee (or $600 for employee and spouse, or single-parent families) payable in September 2022.

Employees who do not receive their annual well visit (physical) with their Primary Care Physician (PCP) between July 1, 2021 and June 30, 2022 will be 1% more in their annual co-shares beginning July 1, 2023.

Wellness Incentive Program

Virgin Pulse Mobile Flyer

Virgin Pulse Registration Instructions

Virgin Pulse Recorded Demo

Doctors Online (Telemedicine) Frequently Asked Questions

Wellness Incentive Program Frequently Asked Questions

IDENTITY AND PRIVACY PROTECTION PLAN FOR ALL EMPLOYEES AND THEIR FAMILIES

Administered by Allstate Identity Protection (InfoArmor)

Website:  https://www.infoarmor.com/

InfoArmor is protection that includes 24/7 high-risk activity monitoring and will provide assistance with recovering and restoring your identity should theft or fraud occur!  Your identity is made up of more than your Social Security number and credit score.  Allstate will also help you look after your online activity, from financial transactions to what you share on social media – so you can protect the trail of data you leave behind.

• Identity monitoring and alters
• Full-service remediation
• Identity theft reimbursement
• iOS and Android app

Enrollment Form

InfoArmor/Allstate Flyer

COORDINATION OF BENEFITS

Active Coordination of Benefits Form

Active FAQ

Applies to spouses/qualified ex-spouses of active employees who have access to health coverage through his/her employer. Working spouses/ex-spouses must enroll in an individual plan with his/her employer. You as the employee will be reimbursed in your bi-weekly paycheck the cost that your spouse gets deducted out of his/her paycheck.

• Your spouse/ex-spouse remains enrolled in full coverage with the City.
• Your spouse/ex-spouse is enrolled in his/her employer’s plan as primary and the City’s plan as secondary.
• You are reimbursed for the cost of the plan (co-share) that your spouse/ex-spouse pays out of his/her paycheck.
• Whatever the spouse’s/ex-spouse’s employer ‘s plan does not cover, the City’s plan covers.
• If the only plan available to a working spouse is an HSA, the spouse does not need to enroll (proof/documentation required)
• Proof and cost of coverage required - see FAQ for details