Employee Benefit & Payroll Information
Payroll Forms and New Hire Packets
- "Welcome To Norwell" Employee Benefit Handbook
- Direct Deposit Form - This form must be completed in person at the Treasurer / Collectors office
- ADP Employee Portal Registration (Access Pay Statements, W2's, Update Tax and Address Information..)
- M4 Form (State Payroll Tax Withholdings) This form must be completed in person at the Treasurer / Collectors office
- W4 Form (Federal Payroll Tax Withholdings) This form must be completed in person at the Treasurer / Collectors office
- 403b Tax Sheltered Annuity Investments Savings (School Only)
- Deferred Compensation SMART Plan Information (Empower Retirement)
- 457 Mandatory OBRA Separation From Employment Request/Withdrawal Request
Insurance Rate Sheet
NEW- FY 2023 Insurance Rate Sheet (Effective 7-1-2022)
Coming Soon- FY 2023 Blue Cross Blue Shield E-Kit & Mobile App. Access the links below for current information and additional benefits!!
FY 2022 Insurance Rate Sheet (Effective 7-1-2021)
One Stop Shopping!! (Click) Access our Blue Cross Blue Sheild E-Kit (Electronic Kit)
When your "On The Go"... (Click) Access our Blue Cross Blue Sheild Mobile Application
If you click the preceding links, you can access the following information all in one convenient spot! Summary of Benefits for Health, Dental and Vision Insurance; Additional Benefits and Member Discounts: Emergency Room Alternatives, Telehealth Brochure, Nurse Hotline, SmartShopper Program, Fitness and Weight Loss Reimbursements, Blue Card Program Brochure, "Commitment To Confidentiality", "How To Choose a Primary Care Provider PCP", Member Identity Protection Services, Find a Doctor, Get Out-of-Pocket Costs, MyBlue Fact Sheet, Diabetes Care Value, Smart90, Mail Service Pharmacy Brochure & Form, $9 Generic Medcations List, 2021 Pharmacy Formulary, 3-Tier Pharmacy Program, $9 Generics Program Fact Sheet
Insurance Summary of Benefits Coverage (SBC)
- FY 2022 BCBS HMO SBC
- FY 2022 BCBS PPO SBC
- FY 2022 BCBS Dental Blue Freedom SBC
- FY 2022 BCBS Vision Blue 20/20 SBC
- 2022 BCBS MEDEX II SBC (Plymouth County Retirees Age 65+)
- 2022 Blue Medicare RX Prescription Drug SBC (Plymouth County Retirees Age 65+)
- Medex II W/PDP 2022 3 Tier Drug Formulary (List of Covered Drugs)
- 2022 Medicare Handbook
Insurance Enrollment & Waiver Forms: Health, Dental & Vision
Important- Please DO NOT fill in your SSN (Social Security Number) on the enrollment forms. Please submit enrollment forms without SSN's; the benefit coordinator in the treasurer's office will call you for this information.
Please Note: We require employees to complete and sign a new "Employee Acknowlegement Form" and "Employee Offer of Insurance Form" with each new benefit enrollment.
- BCBS Health & Dental Insurance Enrollment Form
- BCBS Vision 20/20 Insurance Enrollment Form
- Insurance Waiver Form- Group Health and Life
Additional Benefit Information & Enrollment Forms
- MIIA Employee Wellness Program
- MIIA Employee Assistance Program AllOne Health Website
- Boston Mutual Group Life Insurance Brochure
- Flexible Spending Information: Health and Dependent Care
- Children's Health Insurance Program (CHIP)
- AFLAC Insurance (Voluntary) Norwell Webpage
- UNUM Long Term Disability (Voluntary)
- Allstate (Voluntary)
- Colonial Life (Voluntary- Police & Fire only)