Health Insurance: BCBS

Hampshire County Group Insurance Trust

View the Hampshire Group Insurance Trust Files and Forms.

• 98 King Street, Northampton, MA
  Phone: 413-584-1300

Enrollment Form

View the Enrollment Form (PDF).

• Eligibility / Enrollment Requirements (PDF) (Spouse and Dependents)
• Marital Status Affidavit (PDF) - Must be completed to enroll spouse

HMO Plan

• Employee Single Plan
• Employee + 1 Plan
• Family Plan
• HMO Plan Summary of Benefits (PDF) (effective 7/1/22)
• HMO Plan Summary of Benefits Chart (PDF) (effective 7/1/22)
• Find A Doctor (In-Network)

PPO Plan

• Employee Single Plan
• Family Plan
• PPO Plan Summary of Benefits (PDF) (effective 7/1/22)
• PPO Plan Summary of Benefits Chart (PDF) (effective 7/1/22)

MEDEX Plan (Over 65)

• Medex 2 Plan 2023 - Summary of Benefits (effective January 1, 2022)
• MedicareRx Prescription Plan 2023 - Summary of Benefits (effective January 1, 2022)
• Blue MedicareRx Enrollment Form
• Drug Formulary Book 2023 
• Visit the Social Security website to learn more about Medicare (how to sign up, who qualifies, etc)

CVS Caremark

• New Prescription Information for HMO + PPO members only (effective 7/1/21)
• ExpressScripts is being replaced by CVS Caremark
• All affected members will receive a new CVS Caremark prescription card
• Visit CVS Caremark to create your account (it is quick and easy!)
• You do not have to use the CVS pharmacy - you may continue to use the pharmacy of your choosing
• CVS Caremark Prescription Summary (PDF)
• If you need help/have questions - call the 1-800 phone number on the CVS Caremark letter that you received

Are You (or Your Enrolled Spouse) Turning 65 Soon?

• If so, you will need to apply for Medicare at least 3 months prior to your 65th birthday.
• Please give our office a call so that we can help guide you through this time-restrictive process at 413-665-1400, ext. 102

Active Employee (or Spouse of)

• Apply for eligibility of Medicare Part A (deferring Part B until retirement)
• There is no cost to enroll in Part A and no change to insurance coverage.
• Treasurer's office needs a copy of the Medicare card before you turn 65.

Retired Employee (or Spouse of)

• Apply for Medicare Part A + B
• If eligible, member turning 65 will switch to MEDEX 2 with MedicareRx
• Treasurer's office needs a copy of the Medicare card, completed Enrollment Form, and MedicareRx before you turn 65.

No Copay Prescription Program

• Get name-brand prescriptions for free through CanaRx!
• Eligible for employee subscribers and their enrolled dependents.
• CanaRx Name-Brand Prescription Listing

Fitness Reimbursement (up to $150 / Year)

View the Fitness Reimbursement (PDF).

• New on-demand fitness classes - Unlimited access to 10-60 Minute workouts online!
• Yoga, Barre, HIIT, Kickboxing, Pre-Natal/Post-Natal, Cardio and much more!
• Access Code = HCGIT

Childbirth Class Reimbursement

(Up to $90 for 1st-time parents and $45 for refresher course)

View the Childbirth Class Reimbursement (PDF).

• No Cost Support for Subscribers
• Call-In Maternity Support: 800-392-0098 Monday through Friday 8:30 am - 4:30 pm
• 24/7 Nurse Care Line: 888-247-2583
• Visit the Maternity Page for BCBS
• Living Healthy Babies: BCBS Digital Pregnancy Resource Center

Identity Protection Services

Sign up for the Identity Protection Services for the following free of charge to BCBS members:

• Credit Monitoring
• Fraud Detection
• Credit and Identity Repair

Weightloss Program Reimbursement Form (up to $150 / Year)

View the Weightloss Program Reimbursement Form (PDF).

Subscriber Claim Form

View the Subscriber Claim Form (PDF).

Emergency Room Alternatives

View the Emergency Room Alternatives (PDF).