City of Providence Pre-65 School Employees

Department of People & Culture
Pre-65 School Employees

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

Scan and email to Evelyn Dennis edennis@providenceri.gov

Fax to 401-680-5457

Mail to Providence Public School District, Attn: Human Resources Department, 797 Westminster St. Providence, RI 02903

If you have additional questions, please reach out to the Benefits Office via an email to edennis@providenceri.gov or by phone 401-456-9100 ext. 11125.

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

Qualifying Events include: Marriage/Birth/Adoption/Loss of coverage
Documentation: Marriage License/Birth Certificate/Adoption papers/ HIPAA letter

*ALL CHANGES MUST BE SUBMITTED WITHIN 30 DAYS OF THE QUALIFYING EVENT WITH THE PROPER DOCUMENTATION

OPEN ENROLLMENT

Open Enrollment occurs annually in December and allows you to alter your current health elections for a January 1 effective date.

Benefits Enrollment Form

Medical Benefits

Provided by Blue Cross Blue Shield of Rhode Island
Local – (401) 459-5000
Out of state residents – 1-800-369-2227
Website: www.bcbsri.com

The uniform summary of benefits and coverage (SBC) is a new health plan disclosure required by the health care reform law. The SBC consists of a template document, with coverage examples of common health plan services. These materials, along with a uniform glossary of definitions, serve as a type of executive summary of the more comprehensive SPDs.

School Admin/NU Retirees SBC

School 1339 Retirees SBC

School Teacher Retirees 750 Plan SBC

School Teacher Retirees HMCTC SBC

School 1033 Retirees SBC

School Admin/NU Retirees SBC - No Rx

School 1339 Retirees SBC - No Rx

School Teacher Retirees 750 Plan SBC - No Rx

School Teacher Retirees HMCTC SBC - No Rx

School 1033 Retirees SBC - No Rx

Blue Cross Summaries