Frequently Asked Questions
What is Open Enrollment for health insurance?
Open Enrollment is the period during which employees can enroll in, cancel, or make updates to their health insurance coverage. This is the only time of year, outside of qualifying events (like marriage, loss/gain of alternate coverage or the birth of a child), that employees/retirees or surviving spouses can make changes to their health insurance coverage.
When is Open Enrollment for 2026?
For the 2026 plan year, the Open Enrollment Period runs from February 12 to March 5.
Do I need to enroll in health insurance every year?
No, your health plan automatically rolls over each year.
What documents do I need to enroll my dependents?
- Marriage certificate to enroll a spouse
- Birth certificate(s) or guardianship documentation to enroll dependent child(ren)
What happens if I don’t have health insurance?
If you don’t have health insurance and don’t qualify for an exemption, you may face a penalty from the state, based on Massachusetts State regulations. Please refer to the MA Health Connector site for details at Consumer Guide to the Massachusetts Individual Mandate.
Do I have to participate in Open Enrollment?
You are only required to actively participate in open enrollment if you would like to actively make a change to your current coverage. Otherwise, your rates will be updated to the 2026 rates automatically as of April.
Can active employees enroll in the Blue Cross Blue Shield Advantage Blue plan?
No, this plan is only open to non-Medicare eligible retirees / surviving spouses.
What changes can I make during Open Enrollment?
- Sign up for coverage
- Change from one plan to another
- Add or drop dependents
- Decline coverage (if cancelling coverage, you will qualify for the Health Insurance Waiver Stipend and need to complete forms to enroll).
Health plan elections automatically renew annually.
What is the Health Insurance Waiver?
For benefits eligible employees, the City offers active City and School employees a stipend if they are not enrolled in health insurance through the City. If you are enrolled on your spouse’s coverage, and your spouse also works for the City of Cambridge, you are not eligible for the stipend.
Can I change my coverage outside of Open Enrollment?
Generally, you can only make changes to your health plan outside of Open Enrollment if you experience a qualifying life event such as:
- Getting married
- Having a baby, including adoption or new guardianship
- Losing other health coverage (e.g. due to job loss)
- Moving to a new location out of your plan’s coverage area
- Loss or gain of alternate coverage
- Divorce or legal separation
If you don't have a qualifying life event, you must wait until the next Open Enrollment period to make changes.
What are some key health insurance terms and plan types?
Key Terms
- Deductible: What you pay for care before your plan starts sharing costs
Example: All of our plans have a $0 deductible with the exception of Blue Choice, which has a deductible for self-referred visits.
- Copay: A flat fee you pay when you get care.
Example: Most of our plans are $25 for an office visit or specialist consultation.
- Annual Out-of-Pocket Maximum (OOP): The most you’ll pay in a year for covered care.
After you hit this amount, the plan pays 100% for the rest of the year. The OOP for BCBS plans is $7,150 member/$14,300 family and for Harvard $2,000 member / $4,000 family.
Understanding the Different Plan Types
- Health Maintenance Organization (HMO): Requires using in-network providers and getting referrals for specialists. HMO Blue and Harvard Pilgrim’s health plans are HMOs.
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Point of Service (POS): Requires a primary care physician and referrals, however it does allow for out-of-network coverage. Blue Choice is a POS with two sides. The primary care physician side is an HMO network and the Self Referred (out-of- network) side is an Indemnity plan where members may see any licensed provider but for a much higher cost.
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Exclusive Provider Organization (EPO): Similar to PPO but no coverage for out-of-network care except in emergencies. BCBS’s Advantage Blue plan is an EPO with in-network coverage only (except for emergencies). Members are required to use BCBS’s nationwide network of PPO providers.
- Preferred Provider Organization (PPO): Offers more flexibility to see out-of-network providers at a higher cost. The City does not offer a PPO plan however the Advantage Blue plan is on BCBS’s PPO national network of doctors and hospitals.
Can I add or remove dependents to my plan during Open Enrollment?
Yes, Open Enrollment is the time when you can add or remove dependents on your health insurance plan, such as a spouse or children.
What if I miss the Open Enrollment period?
If you miss the Open Enrollment period and don’t have a qualifying life event, you won’t be able to make changes to your coverage until next year’s Open Enrollment.
What other benefits are available during Open Enrollment?
This Open Enrollment season is only for health insurance. Your health plan options are:
Active Employees
- Blue Cross Blue Shield HMO Blue
- Blue Cross Blue Shield Blue Choice
- Harvard Pilgrim Health Care HMO
Retirees/Spouses/Survivors
- Blue Cross Blue Shield Advantage Blue (Retiree Only Plan)
- Blue Cross Blue Shield HMO Blu
- Blue Cross Blue Shield Blue Choice
- Harvard Pilgrim Health Care HMO
What if I don’t want health insurance through the City?
If you are choosing to cancel your health insurance plan, you may do so via the vendor's online portal or complete and submit an enrollment form. Be sure to also complete the Health Insurance Waiver to receive the stipend after disenrolling if you are cancelling coverage and not receiving coverage through a spouse who also works for the city.
Will my premiums change from last year?
Premiums will change as of April 1 and will be reflected as of the first payroll in April for active employees or the April pension for retirees / surviving spouses. Please see the Health Plan Comparison Guides / Rate Sheets.