Health Insurance Information

Employees can enroll in, cancel, or make changes to health insurance coverage during Open Enrollment in February each year, or anytime a Qualifying Life Event (QLE) occurs. If you are making a change due to a QLE, it will require documentation and must be made within 60 days of the effective date of that event.

Newly hired employees should review plan options and submit benefit elections within 30 days of your start date. Elections submitted after this deadline will fall outside the new hire eligibility window and cannot be processed. Please view specific information in New Hires section.

Health Insurance Plans

The City of Cambridge offers Health Insurance plan options through Blue Cross Blue Shield and Harvard Pilgrim.

Summary of Benefits and Coverage

• Blue Cross Blue Shield - Blue Choice
• Blue Cross Blue Shield - HMO Blue
• Harvard Pilgrim

View Health Plan Comparison Guide

Blue Cross Blue Shield Additional Benefits

• Fitness Reimbursement: Up to $300 reimbursement for qualified gym/health club membership, other fitness studio, fitness membership, equipment, etc.
• Weight-Loss Reimbursement: Up to $300 reimbursement for hospital programs, Weight Watchers, food supplements, nutrition counseling, exercise equipment.
• Mind & Body: Up to $300 reimbursement for qualified holistic care such as massage, hypnosis, meditation, Tai chi, Qi gong, and breathing and meditation apps.
• PillarRX: Save money on specialty and other expensive drugs with this high-cost drug discount program.
• Sempre: Save money with this drug discount program for chronic conditions.

For more information, call 1-800-782-3675 or visit www.bluecrossma.org.

Harvard Pilgrim Additional Benefits

• Weight Management Reimbursement: Up to $300 reimbursement for qualified weight management program.
• Wellness Reimbursement: Get reimbursed for fees you pay toward wellness activities — up to $300.
• Good Measures: Digital nutritional counseling program at no charge for members.
• Vision Benefits & Discount Programs
• Doctor on Demand: HPHC partner providing virtual medical and Behavioral Health services.
• Discounts and Savings: Various discounts and savings perks.
• Out-of-Area Dependent Coverage
• OVIA Health: Support to help you and your family through some of life’s biggest transitions.

For more information, call 866-874-0817, email SmartStart@point32health.org, or visit www.harvardpilgrim.org.

Enrolling in Health Insurance?

Review plan options and rates on the Health Plan Comparison Guide. Once you have chosen a plan, complete the applicable enrollment forms that can be filled, signed, and submitted electronically.

Enroll or Modify Your Health Insurance Coverage

Coverage may be effective as early as the effective date of your qualifying event or within 30 days of that date. Retroactive payroll adjustment(s) may be taken to cover the cost. Please complete and submit your information promptly to minimize retroactive premium adjustments. You should receive your card(s) for health insurance and pharmacy coverage within 10 business days.

Cancelling Health Insurance / Signing Up for Health Insurance Waiver Stipend?

Active City employees have the option of cancelling their health insurance and signing up for the Health Insurance Waiver Stipend during Open Enrollment in the winter, or due to a Qualifying Life Event (QLE). This stipend amount varies based on your union/non-union status as well as union affiliation. Non-union employees receive a stipend of $225 a month.  For information regarding the waiver stipend for union positions, please review the collective bargaining agreements or contact the Benefits Office at benefits@cambridgema.gov. Documentation which includes confirmation of the effective date of your qualifying event within the past 30 days will be required.

Note: Not all unions offer the health insurance stipend.

Enroll or Modify Your Health Insurance Coverage

Health Claims Advocacy, Concierge Services & Appeals Processes

Claims Advocacy and Concierge Services

Employees have access to claims advocacy and concierge services through our benefits broker, NFP.  These services are designed to help navigate common insurance and benefits issues that can be time-consuming or frustrating to resolve on your own.

Claims Advocacy Services include:

• Assistance with claims resolution and approvals
• Support with claims, denials and appeals
• Help with reimbursement requests
• Assistance resolving medical bill disputes

Concierge Services include:

• Support with prescription-related issues
• Answers to provider network and coverage questions
• General assistance navigating your health benefits

To access these services, please or email NFP directly:

• Monday through Friday: 9AM EST – 6PM EST
  Toll Free Number: (877) 835-1361/Option 1
• Email for Claims Advocacy: CSclaims@nfp.com
• Email for Concierge Services:  DBbenadmin@nfp.com

Please note: For privacy reasons, our internal City Benefits team is unable to assist with most claims-related or personal health insurance inquiries. NFP’s services closes the gap by providing employees with direct, confidential support from benefits experts.

We encourage employees to take advantage of this resource whenever questions or issues arise.

Appeals

If a service or prescription is denied, you may submit an appeal directly to your health plan.

Please note that the City does not review, approve, or deny claims or appeals, as we do not have an internal appeals review process. To help ensure that all appeals are handled fairly and consistently, they are reviewed and decided by the health plan. Once the appeals process is complete, the City follows the plan's final determination.