FY 2022 Open Enrollment/Benefits Fair Information
Open Enrollment Period: May 1, 2021 through June 1, 2021
Benefits Effective Date: July 1, 2021
Please note there are no major changes in benefit providers. We are still with BCBS/MIIA, Dental Blue, VSP and TASC.
Please email, mail or drop off at the Superintendent's Office any forms you need to complete by June 1, 2021. They can be submitted to the Town Treasurer's Office or the School's Business Office. The contact information is listed on Ms. Marlborough's letter.
FY 2022 Open Enrollment/Benefits Fair Letter 4-23-21
Health Insurance Coverage Information:
FY 2022 Health Insurance Rate Sheet
BCBS HMO Blue Select Information
BCBS HMO Blue Select Information - Outside Reliant Doctors
BCBS Elect Information - Out of State
If you want to receive the annual stipend for opting out of Millbury's health insurance, please complete the enclosed form:
Health Insurance Opt Out Application
Dental Insurance Coverage Information:
BCBS Dental Blue Freedom Information - High Plan
BCBS Dental Blue Freedom Information - Low Plan
The TASC Flexible Spending Account Application needs to be submitted each year.
TASC Flexible Spending Account Application and Information
The Federal and State Tax Withholding Forms are here for informational purposes only. Employees do not need to complete these on an annual basis. Many employees have asked for these two forms so we have placed here on the annual open enrollment site.
W-4 Federal Withholding Form
M-4 State Withholding Form
Information added on 5-10-21
Smart Shopper Quarter 2 Newsletter
AFLAC Voluntary Disablity Insurance Information:
AFLAC - MPS Open Enrollment Webpage
Note: This AFLAC webpage link will only be active during the Open Enrollment Period.
AFLAC Representative Information is:
Nancy J. Sherman
71 Spit Brook Rd. Suite 209
Nashua, NH 0306