Kathy Famiglietti Insurance & Benefits Coordinator
Middletown Public Schools 311 Hunting Hill Avenue Middletown, CT 06457
Phone: 860-638-1409 Fax: 860-638-1457
[email protected]
Connecticut Partnership Plan 2.0 - Administrators, Teachers & Paraprofessionals (Effective 10/1/2020):
Anthem/Blue Cross/Blue Shield --- State Bluecare POS (Medical): Quality medical coverage with you in mind - Brochure SBC State Partnership Plan (Effective 7/1/2021 to 6/30/2022)
State of CT Upswing Health - Non Emergency Orthopedic Tool
State of Connecticut Partnership Plan - Add/Terminate/Change Form Health Enhancement Program (HEP):
HEP Physician Notification Form (PNF) 2020 HEP Frequently Asked Questions - 2020
CVS Caremark (Pharmacy): https://www.caremark.com/wps/portal
Cigna Dental
Cigna Dental PPO - Administrators Cigna Dental PPO - Teachers and Paraprofessionals
State of Connecticut Cigna Dental Care DHMO Patient Charge Schedule eff 5/1/2019 (Administrators, Teachers and Paraprofessionals Only)
Lincoln Term Life Insurance: Beneficiary Designation Form
Student/Sports Accident Insurance:
Bollinger Student Voluntary Insurance Claim Form and Instructions 2020-2021 Bollinger Student/Athletic Insurance Claim Form and Instructions 2020-2021 (Accident Excess) Student Accident & Injury Report
Student ATHLETE Accident & Injury Report for Coaches and Trainers
Worker's Compensation (CIRMA) Information (Click on this link for more information and forms)
Revised Notice of Privacy (Click on this link)
Federal Health Insurance Marketplace or "Exchange" Notice
General Cobra Continuation Election Notice Creditable Coverage Letter 2020 State Partnership Plan