4 Summer St., Rm 104, Haverhill, MA 01830 | Office Hours 8:00-4:00 | Phone (978) 374-3411 | Fax (978) 374-3422
This page will help you find a wealth of information to help you make the most of your health insurance. The GIC offers 11 health plans with:
AllWays Health Partners – (Summary of Benefits and Coverage)
Fallon Health Direct Care – (Summary of Benefits and Coverage)
Fallon Health Select Care – (Summary of Benefits and Coverage)
Harvard Pilgrim Independence – (Summary of Benefits and Coverage)
Harvard Pilgrim Primary Choice – (Summary of Benefits and Coverage)
Health New England – (Summary of Benefits and Coverage)
Tufts Health Plan Navigator – (Summary of Benefits and Coverage)
Tufts Health Plan Spirit – (Summary of Benefits and Coverage)
UniCare Indemnity Basic – (Summary of Benefits and Coverage)
UniCare Indemnity Community Choice – (Summary of Benefits and Coverage)
UniCare Indemnity PLUS – (Summary of Benefits and Coverage)
Important: The GIC health insurance enrollment form must be completed and submitted within 10 calendar days from your first day of employment.
Your health insurance begins on the first day of the month following 60 days or two full calendar months of employment, whichever comes first. Please reference the GIC Effective Date Chart to confirm the effective date of your health insurance. The deductions are pre-tax, bi-weekly and deducted from 20 paychecks.
Please reference the GIC End of Coverage Date Chart which will show when your health insurance coverage will end if you leave Haverhill Public Schools.
Health Insurance Forms:
Benefit Decision Guide 2019-2020 – Coverage Effective 7/1/19-6/30/20
Benefit Decision Guide 2020-2021 – Coverage Effective 7/1/20-6/30/21
Bi-Weekly Rates – 2019-2020
Bi-Weekly Rates – 2020-2021 – Current Employees – Deductions begin May 29, 2020
Enrollment / Change Form
Dependent Ages 19 to 26 Enrollment-Change Form
Required Documentation for Coverage
Handicapped Dependent Application
Status Change Form
ACA Marketplace Notice
COBRA General Notice FY19
COBRA General Notice FY21
If enrolling spouse and/or child(ren) you will need to provide a copy of your marriage certificate and children’s birth certificate.
Things to consider when choosing a health plan:
1. Is your Doctor and Hospital in the plan’s network?
2. What is the co-payment tier for your PCP, Specialist and Hospital?
3. What is the per paycheck/bi-weekly rate for the plan?
4. Contact the health plans to ask questions – GIC Health Plan Contact Sheet.
5. GIC – Compare The Plans Summary (2019-2020)
Frequently Asked Questions:
Dependent Ages 19 to 26 FAQs
Qualifying Life Events and Your Options FAQs
Divorce, Legal Separation and Remarriage FAQs
Express Scripts (ESI) manages the prescription drug benefit for ALL GIC Health Plans. ESI issues two ID cards in the main subscriber’s name. All health plans will have the same prescription ID card and the cards will not reference the health plan name.
Please contact ESI to review your current prescriptions and find out if the medication is covered and at what copay. You can contact ESI at 855-283-7679 or www.express-scripts.com.
Wellness Programs and Discounts
The GIC’s health plans offer the following gym membership reimbursements. Contact the individual health plan or click on the below fitness reimbursement information sheet to find out what other services may be covered under this program, whether the reimbursement is on a fiscal (plan or benefit year) or calendar year, other wellness programs, and to get a gym membership reimbursement form. GIC Gym Reimbursement Per Health Plan
Fallon Health – FITNESS REIMBURSEMENT Information Sheet
Harvard Pilgrim – FITNESS REIMBURSEMENT Information Sheet
Neighborhood Health Plan – FITNESS REIMBURSEMENT Information Sheet
Tufts Health Plan – FITNESS REIMBURSEMENT Information Sheet
UniCare State Indemnity Plan – FITNESS REIMBURSEMENT Information Sheet