Employee Forms and Information

Town Seal ImageView current and former employee benefit information and access frequently needed forms.

Forms

  1. M-4 Form (PDF)
  2. W-4 Form (PDF)
  3. 2022 HSA payroll deduction

Summary of Health Benefits

  1. FY23 WSHG Plan Comparison All
  2. FY23 WSHG Plan Comparison Benchmark
  3. FY23 WSHG Plan Comparison HSA

Open Enrollment Forms - Retiree Plans

  1. 2021 EG HMO Enrollment Form FILLABLE
  2. 2021 EG MEDSUPP_PDP Enrollment Form FILLABLE
  3. EGWP21_Enrollment Form_Broad_Fillable
  4. EGWP21_Enrollment form_WORC_fillable
  5. NEW MA.MEDICARE_ENHANCE_FORM_FILLABLE_WITH AETNAPDP

Retiree Medicare Supplement Plans

  1. Retiree rates 11.24.2020
  2. Retiree-WSHG-Medicare-Advantage-HMO-2021-plan comparisons
  3. Retiree-WSHG-Medicare-Supplement-2021-plan comparisons
  4. 2023 EG HMO Enrollment Form
  5. 2023 EG MEDSUPP_PDP Enrollment Form
  6. 2023 FallonMedicarePlusPremier Kit
  7. 2023 FallonMedicarePlusPremier Kit Form Fillable
  8. 2023 FallonMedicarePlusPremier WorcCounty Kit
  9. 2023 FallonMedicarePlusPremier WorcCounty Kit Fillable
  10. 36-3630_Member_Enrollment_Form
  11. 55-0928_2023_GroupEnrollForm
  12. Medicare D Creditable Coverage Notice 10.2022
  13. NEW MA.MEDICARE_ENHANCE_FORM_FILLABLE_WITH AETNAPDP
  14. Retiree health insurance Open Enroll Memo 11.2022
  15. WSHG CY23 Sr Plan rates
  16. WSHG Medicare Advantage HMO Plan Comparison
  17. WSHG Medicare Supplement Plan Comparison

Active employee Basic Life Insurance

  1. Boston Mutual Life Insurance Enrollment Form