Department of
Human Resources
Madison, Connecticut
8 Campus Drive, Madison, CT 06443
Monday - Friday, 8:30 a.m. - 4:00 p.m.

For information regarding your Anthem Blue Cross Blue Shield coverage, you can request information on your summary plan document by calling 800-233-4947 and providing your Subscriber number (located on your card).

Description of Benefits:

Century Preferred

BlueCare

Dental Plan Summary

Forms:

Anthem Enrollment/Membership Change

Anthem Claim Form

Anthem Rx Direct Order Form

Flexible Spending Account
- Request for Reimbursement

Life Insurance Enrollment & Change Form

Payment in Lieu of Benefits

FMLA Brochure (Overview of FMLA)

Notice of Obligations - Outline of the Obligations of Employees Who Take FMLA

Employee Request for FMLA Form

Retirement plan summary for the Employees of the Town of Madison, CT