Medicare Supplement

Form

Description

2021 premiums for medical and dental plans for active employees, retirees and COBRA participants.

Retiree Health Reimbursement Form - Retirees use this form to request reimbursement from the HRA account after you have left the Choice plan. Premiums or qualified expenses may be used.

This coverage requires enrollment in Medicare Parts A & B.

 

Summary of the City's Hartford supplement. Participants should have received this from Benistar. The Medicare figures will change, but not the participant’s out of pocket.  
 

Provided through Express Scripts: chart of 2021 benefits. Medicare Part D Coverge.

Plan Administrator 

Questions About this Coverage

and How It Works

Benistar Employer Services Trust (BEST)

Customer Service Department - (860) 408-7000, ext. 230 

Contact:

Peter Wright, Wright Benefit Strategies, Inc.
847.996.6900 phone
peter@wrightbenefit.com
www.wrightbenefit.com

Form used to submit dental claims.

The City of Lake Forest complies with all HIPAA privacy requirements with regard to your personal health information. Our privacy practices are found here.   

Our Notice about your Prescription Drug Coverage and Medicare Part D for the Employee Choice Plan is found
here and for the Basic Plan is found here

The Women's Health and Cancer Rights Act of 1998 requires that all employees be notified on an annual basis of their coverage, and can be found here.