Health & Dental Contributory Retirement Rate Chart
Insurance Rate Chart for Contributory Retirees. This does not include the Contributory Retirement Subsidy Amounts. Anthem Medicare Preferred rates guaranteed until 12/31/2013.
Health & Dental New Hampshire Retirement Rate Schedule
Insurance Rate Chart for New Hampshire State Retirees (Police & Fire) including the NH Subsidy Amounts. Anthem Medicare Preferred rates guaranteed until 12/31/2013.
Delta Dental Outline of Benefits
Delta Dental Outline of Benefits.
Delta Dental Plan Booklet
Detailed booklet explaining your dental coverage; what is covered and at what percentage it is covered, etc.
Delta Dental Provider Directory
A directory of participating Delta Dental Dentists.
Delta Dental Vision Discount Program
Free Vision Discount Program offered by Delta Dental. Great savings of up to 35%.
Silver Sneakers Program
Brochure explaining the Silver Sneakers Fitness program offered by Anthem. It offers health education, social events, a website and membership into nearly 10,000 locations across the country.
24 Hour Nurse Line Brochure
Brochure explaining Anthem's 24 hour Nurse Line.
Special Offers By Anthem
Brochure of Special offers and discounts offered by Anthem Blue Cross and Blue Shield.
Health Insurance Cancellation Form
Read/sign this form and complete the Health Insurance Disenrollment form below if you wish to cancel your health insurance.
Health Insurance Disenrollment Form
Complete this form and read/sign the Health Insurance Cancellation form above if you wish to cancel your health insurance.
Dental Enrollment/Change Form
This form is to terminate, enroll in or make changes to your dental insurance.
Health Insurance Enrollment/Change Form
This form is to enroll into Anthem's Medicare Preferred PPO plan.
NH Retirement Annuity Deduction Authorization Form
Fire & Police retirees, you must complete this form if you are making any changes that affect your health and/or dental insurance premiums.
Mail Order Prescription Drug Form
To order a new prescription from Express Scripts Mail Order Pharmacy complete this form
Prescription Drug Claim Reimbursement Form
Use this form to request reimbursement for a prescription drug you paid out of pocket
Health Insurance Individual Authorization Form
This form is to enable another individual to call Anthem Blue Cross & Blue Shield on your behalf.