Employment Benefits

General Information

Employees pay their premiums one month before their coverage starts. Insurance will be effective on the 1st day of the month following the employee’s date of hire.

  • Who is eligible for insurance?
    • Employees who average over 20 hours per week, their spouses (domestic and common law partners are not eligible), ex-spouses (if court-ordered), and dependents until the age of 26. A copy of a marriage certificate will be required to add a spouse, copies of birth certificates are required for each dependent, and Social Security numbers are needed for all plan members. 
  • When can employees enroll or make changes to coverage?
    • As a New Hire (paperwork must be submitted in the first week of employment)
    • Within 30 days of a Qualifying Event such as:
      • Loss of coverage
      • Birth or Adoption
      • Marriage or Divorce
    • During the annual Open Enrollment period (paperwork is submitted in April for coverage effective July 1st).

Health Insurance

  • The City’s health insurance carrier is Blue Cross Blue Shield of Massachusetts and is a Fiscal Year benefit (7/1-6/30)
  • The City pays 75% of the total premium and Employees pay 25%
  • Employees can choose from the following options: 
      • An HMO—members will need to consult their primary care physician for a referral before seeing a specialist
      • Prescriptions are handled through a separate Pharmacy Benefit Manager called Maxor Plus. Members receive a Maxor card in addition to a Blue Cross card. See the Prescription Coverage section for more information.
      • New England based network—all primary care needs to occur with Blue Cross providers in the New England states.
      • Members are covered outside New England on an emergency basis only.
      • Prescription coverage through Maxor Plus
      • A qualified high-deductible health plan (HDHP) with a Health Savings Account (HSA) through Health Equity.
      • Members have a higher deductible and out-of-pocket max but lower bi-weekly premiums.
      • Members can contribute to a Health Savings Account (HSA) to use for health-related expenses (either now or in the future)
      • The City will fund the HSA with $1,000 for an individual plan and $2,000 for a family plan in bi-weekly installments throughout the year. Employees can contribute an additional $3,150 for an individual plan or $6,300 for a family plan.
      • Savings are pre-tax and money grows tax-deferred
      • HSA funds roll over from year to year and are portable even if you change jobs
      • Prescription coverage is through CVS Caremark
    • Blue Care Elect (For Active Employees and Retirees who have members on their plan living outside New England)
      • A PPO
      • Contact Human Resources for more information.
  • As of July 1, 2024 the health and wellness benefits included with the Blue Cross coverage have expanded to offer more options:

    • Aetna (For Medicare Eligible Retirees and their spouses)
      • Effective July 1, 1997 the City of Fall River adopted Mass. General Laws, Chapter 32B, Section 18 which requires all Medicare-eligible retirees and their spouses on the City’s health insurance to enroll in Medicare Parts A and B and transfer to a Medicare Supplement. Effective July 1, 2021 the City and Public Employee Committee (PEC) expanded eligibility by agreeing to purchase Medicare Part A for retirees who are ineligible for free Medicare Part A and requiring all retirees to enroll in Medicare Parts A and B and transfer to a Medicare Supplement.
      • You Might Get Parts A and B Automatically if you are already receiving benefits from Social Security or are under 65 and disabled. If you are automatically enrolled, you will get a Medicare card in the mail about 3 months prior to your 65th birthday or 25th month of disability.
      • You Might Need to Sign Up for Parts A and B if you aren’t getting Social Security Benefits or qualify for Medicare because you have End-Stage Renal Disease (ESRD).
      • If you do not qualify for free Medicare Part A you will need to enroll and notify the City so we can pay your Part A Premium. Members will be responsible for their Medicare Part B premium as well as any income related penalties. If a member does not provide the required Medicare information, they will not be eligible to continue their health coverage through the City.
      • The City of Fall River partners with Retiree First, a firm that specializes in municipal retiree health and drug programs. The Retiree First team will assist with your enrollment and be your personal contact and advocate anytime you need help with your Medicare Supplement which is through Aetna and is a calendar year benefit. The City pays 75% of the total Aetna premium and retirees are responsible for 25%.
      • If you are Medicare eligible or will soon be Medicare eligible reach out to Retiree First, the City's liaison to Aetna, at 508-300-9697 to start the enrollment process.
      • How having a spouse or child on your plan affects your coverage
        • If you are on a family plan with a spouse only, the Medicare Eligible member will transfer to Aetna, while the non-Medicare eligible member remains on the active plan (at an individual premium) until they are also eligible for Medicare.
        • If you are on a family plan with a spouse and dependent or multiple dependents, you will still need to enroll in Medicare Parts A and B but will not transfer to Aetna until the plan is down to two members. You will remain on the active plan until then.
        • If you are on a family plan with a dependent only, the Medicare Eligible member will transfer to Aetna while your dependent remains on the active plan (at an individual premium) until the first day of the month following their 26th birthday or they are voluntarily removed.

Free Prescription Drug Programs

  • Our plans include access to two additional FREE prescription drug programs. Members can get certain brand-name medications by mail for no copay.
    • CANARX
      • You can find a full list of covered medications on our member website at https://www.canarx.com/ and use the plan ID FALLRIVER, or call the customer service team at 1-866-893-6337.

    • ElectRx
      • Contact Customer Service at 1-855-353-2879.

  • We advise members to fill their scripts in this order:
    1. Use CANARX or ElectRX to get eligible drugs at no copay.
    2. Mail Order through Aetna, Maxor Plus, or CVS Caremark for a reduced copay.
    3. Fill in as needed through retail pharmacy for your regular copay.

Diabetes Care Rewards Program

(For Active Employees)

Blue 20/20 Vision Insurance

(For Active Employees)

  • Voluntary program and the full 100% cost is paid by the employee
  • Fiscal Year benefit (7/1-6/30)
  • Option for members looking to supplement their normal Blue Cross vision benefits or for members not enrolled in the health insurance to pick up an additional benefit.
  • Employees do not have to be enrolled in health insurance to elect vision insurance
  • Separate vision plan providing coverage for routine eye exams, frames/lenses and contacts.

Dental Insurance

(For Active Employees and Retirees)

  • The City’s dental insurance carrier is Altus Dental and is a calendar year benefit (1/1-12/31)
  • The City offers 3 different dental plans.
    • Base Option 1
      • 50/50 Plan (You pay 50% the insurance company pays 50%)
      • $500 Annual Maximum
    • Buy-Up Option 2
      • 100/50 plan (Preventative and Diagnostic treatment covered at 100% after $50/$150 deductible) everything else covered at 50%.
      • $1,000 Annual Maximum
    • Buy-Up Option 3
      • 100/80/20 plan (Preventative and Diagnostic treatment covered at 100% after $50/$150 deductible), everything else covered at 80% and 50% (implants, crowns, bridges, partials).
      • $1,500 Annual Maximum
  • Open enrollment works differently for dental insurance—members can increase coverage but cannot lower coverage for at least 2 years.
  • The 75/25% Cost share is based on the Option 1 premium only
  • No orthodontic coverage on any of the plans. Active employees might want to look into the Flexible Spending plan to help offset the cost of orthodontics.

Group Life Insurance
(Coverage must be selected at time of hire)

  • Basic Life
    • A $5,000 death benefit.
    • The City pays 75% of the monthly premium and Employees pay 25%.
    • There is no cash value to this policy.
    • If the member retires through the City this policy will continue.
    • Not a portable policy—terminates with employment.
  • Voluntary Life
    • The employee pays 100% of the monthly premium.
    • Employee must enroll in the basic life to take voluntary.
    • Can get up to $100,000 policy guaranteed (or up to 5 times their salary with medical clearance).
    • Employees can insure their spouse and dependents (employee must take voluntary insurance for themselves first in order to insure spouse and dependents).
    • Spouse can be insured for half of what the employee elects or a max of $30,000
    • Dependents can be insured for $5,000 for an additional $.95. 
    • Age based rates—rates change in 5-year increments.
    • Policy ends at retirement or age 75, whichever comes first.
    • No cash value.

Individual Life Insurance / Disability

  • Colonial Life
    • Contact Kimberly Cunningham 401-596-1510 or Kimberly.cunningham@coloniallifesales.com
    • Disability Insurance
    • Accident Insurance
    • Critical Illness
    • Term and Whole Life

Flexible Spending Account

(For Active Employees Only)

  • The City’s FSA carrier is Cafeteria Plan Advisors
  • This is a voluntary program, and the full cost is paid by the employee.
  • The FSA plan is administered on a school year basis (10/1-9/30)
  • Allows employees to set aside $3,200 pre-tax per plan year for medical expenses and up to $5,000 pre-tax per plan year for dependent care (i.e. children in daycare or parents who require elder care).
  • Cost to employees is $4.50/month.
  • Remaining balances up to $640 will roll over to the next plan year.
  • Employees receive a lump sum of what they elect day 1 and then money is taken out of their check throughout the year.
  • Employees enrolled in the HSA through the Access Blue medical plan are only eligible for the Limited FSA option
  • Contact Karen Smith 781-848-9848 or info@cpa125.com

Deferred Compensation

  • Money is withheld from your pay either pre-tax or post-tax and put into a retirement account (457b or 403b)
    • Like a 401(k) alternative (without an employer contribution).
    • Used to supplement your retirement.
  • This is a voluntary benefit that can be started or stopped at any time.
  • The City partners with three deferred compensation carriers