2022 City of Boston Opt-Out Program

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f you choose to receive coverage under another medical plan outside of the City of Boston’s group coverage, you may waive the City of Boston plan and receive an annual Opt-Out payment through your paycheck. The Annual Enrollment period for the Opt-Out Program will remain open until Friday, June 24th. This process will include submitting a personalized Google form and providing supporting documentation.

The annual Opt-Out payment amount is $1,000.00 or $1,500.00 annually for waiving an individual health insurance plan or $1,500.00 or $2,500.00 annually for waiving a family health insurance plan (whichever applies under your collective bargaining agreement). The opt-out payment will be issued as a lump sum in one of your payroll checks.

Please note the amounts you receive under this plan are subject to federal, state, and Medicare taxes.

ELIGIBILITY

You may be eligible to participate if you are:

  1. Currently enrolled in medical coverage through the City of Boston AND drop the coverage during the Opt-Out Open Enrollment period for at least one year; OR
  2. Your collective bargaining agreement states that you qualify because you had City of Boston health insurance coverage for at least one year during your employment with the City and had previously dropped the coverage.

In either case, you must have coverage under another plan in order to receive the payment. Other plans include:

  • Your spouse’s/ partner’s plan (as long as they are covered by someone other than the City of Boston, Boston Water & Sewer Commission or the Boston Public Health Commission);
  • A private plan;
  • A plan offered through a second employer (if you have another job that provides health care benefits); OR
  • A retiree health plan from an employer other than one of the City of Boston groups

Please note you are not eligible for the Opt-Out program if you have health insurance through another City of Boston plan, Boston Water & Sewer Commission, or the Boston Public Health Commission.

HOW TO APPLY

  1. Request and obtain a verification letter of alternative coverage. This letter is proof that you have continuing coverage elsewhere and must be on employer letterhead or the certificate of credible coverage from the health insurance company. The letter must include the following information:
    • Your full name
    • Name of health plan you are enrolled in
    • Date coverage began
    • Indication that coverage is continuing
      • You are applying for the opt-out benefit effective July 1, 2022, therefore your letter must prove that you will have coverage elsewhere effective July 1, 2022.
    • Representative signature (if on employer letterhead)
    • Only if you are applying for the family benefit: Copy of your marriage certificate or one of your dependent’s birth certificate
      • If you filed for a marriage license in Boston, you can get a certified copy of your marriage certificate in-person, online, or by mail. Learn more here.
      • You can get a copy of a birth certificate for yourself or anyone who was born at a hospital or home in Boston, or whose parents listed Boston as their residence at the time of the birth. Learn more here.
    • Non-Acceptable Proof of Coverage:
      • Copy of Health Insurance Card
      • Tax form(s): 1099 HC, 1095 Form(s)
      • Website Health Plan Information Printouts
  2. Submit this online form and upload your letter of verification by June 24, 2022.

WHAT IF I NEED TO REJOIN THE CITY’S HEALTH PLAN?

If you waive coverage, receive your cash benefit, and then rejoin the City of Boston’s medical plan at a later date, you must pay back a certain amount of the annual Opt-Out payment. The amount you pay back will be prorated to reflect the period for which you received payment minus the number of months that you will now be covered by one of the plans offered by the City of Boston.

If you waive coverage and then lose your other coverage during the City of Boston’s medical plan year, you can rejoin the plan by:

  1. Notifying the City of Boston within thirty (30) days of the date of insurance cancellation;
  2. Providing verification of loss of coverage; and
  3. Enrolling in a medical plan offered by the City.

Please note if you do not enroll in a City health plan within the 30 days, the City of Boston will not be responsible for any medical claims you incur after your loss of other coverage, and you must wait until the next Open Enrollment period to reapply for coverage.

QUESTIONS?

Submit a ticket through the Beacon portal or contact the Health Benefits Office by email at hbi@boston.gov or by phone at 617-635-4570.

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