• Home
  • Collapse menu item City GovernmentCity Government
    • Collapse menu item DepartmentsDepartments
      • Animal Control
      • Assessors
      • Chief Financial Officer
      • City Clerk
      • Community Development
      • Comptrollers
      • EDIC
      • Elder Services
      • Elections
      • Emergency Management
      • Fire Department
      • Information Technology (I.T.)
      • Inspectional Services
      • Law
      • Parking Department
      • Parks & Recreation
      • Personnel
      • Planning Department
      • Police
      • Public Health
      • Public Library
      • Public Works
      • Purchasing
      • Treasurer/Collector
      • Veterans Services
      • Harbormaster and Shellfish Constable
    • Lynn Public Schools
    • Expand menu item Mayor's OfficeMayor's Office
      • Mayor's Staff
      • Newsletter
      • Office Hours
      • DEI
      • Initiatives
      • Community Resources
      • Social Media
    • Expand menu item City CouncilCity Council
      • City Council Members
      • Committees
      • Meeting Information
      • Contact
      • Archive
      • Interpretation/Translation Services
    • Expand menu item Boards & CommissionsBoards & Commissions
      • Affordable Housing Trust Fund
      • Board of Health
      • Charter Review Committee
      • Citizens Advisory Board
      • Conservation Commission
      • Council on Aging
      • Cultural Council
      • Disability Commission
      • Election Commission
      • Emergency Planning
      • Food Policy Council
      • Grand Army of the Republic (GAR) Trustees
      • Historical Commission
      • Human Rights Commission
      • LHAND Commission
      • Licensing Commission
      • Lynn Calm Team Community Advisory Committee
      • Lynn Community Television
      • Municipal Finance
      • Off-Street Parking
      • Park Commission
      • Pine Grove Cemetery Commission
      • Planning Board
      • Public Arts Commission
      • Public Library Trustees
      • Retirement Board
      • Stadium Commission
      • Traffic Commission
      • Wage Theft Advisory Committee
      • Water & Sewer Commission
      • Zoning Board of Appeals
      • Cable Television Advisory Committee
      • Residency Compliance Commission
    • Expand menu item American Rescue Plan Act (ARPA)American Rescue Plan Act (ARPA)
      • Lynn's ARPA Dashboard
      • ARPA Funded Projects
      • For Subrecipients
      • For City Departments
      • Closed Bids
    • Expand menu item Diversity, Equity, & InclusionDiversity, Equity, & Inclusion
      • The Lynn CALM Team
      • The REAL Team
      • Language Access
    • Non-Discrimination Policies
  • Expand menu item CommunityCommunity
    • Accessibility
    • Gannon Municipal Golf Course
    • High Rock Tower Reservation
    • Expand menu item King's BeachKing's Beach
      • Steering Committee
      • Initiatives
      • Email List
    • Lynn Housing Authority & Neighborhood Development
    • Lynn Water & Sewer Commission
    • Lynn Public Library
    • Expand menu item Municipal MeetingsMunicipal Meetings
      • Assessors
      • Community Television Inc.
      • Citizen's Advisory
      • City Council
      • Committee of the Whole
      • Conservation Commission
      • Council On Aging
      • CMCC | CDC Boards
      • Cultural Council
      • Disability Commission
      • EDIC
      • Emergency Management
      • Emergency Planning
      • Board of Health
      • Historical Commission
      • Housing Authority
      • Human Rights Commission
      • Library and GAR Trustees
      • Licensing Commission
      • Lynn PAC
      • Pickering Building Committee
      • Municipal Finance Corp.
      • Off Street Parking
      • Park Commission
      • Pine Grove Commission
      • Planning Board
      • Public Arts Commission
      • Public Hearings | Other
      • Residency Compliance
      • Retirement Board
      • School Committee
      • Stadium Commission
      • Traffic Commission
      • Water Sewer Commision
      • Zoning Board of Appeals
      • Food Policy Council
    • RAVE/Smart 911
    • Report an Issue
    • Resident Resources
    • Rodent Control
    • Street Sweeping
    • Trash & Recycling Information
    • Yard Sale Listings
    • Summer Youth Employment Program
    • Lynn Interim Station & Ferry
  • Expand menu item How Do I?How Do I?
    • Expand menu item PayPay
      • Parking Ticket
      • A Bill
    • Expand menu item Apply/RegisterApply/Register
      • For a Job
      • To a Board/Commission
      • For a Building Permit
      • For a Marriage Certificate
      • For a Senior Tax Exemption
      • For Canning
      • To Vote
    • Expand menu item RequestRequest
      • Animal Control
      • Trash Pick-Up
      • Trash/Recycling Barrel Repair
      • Vote by Mail Ballot
      • Public Records
      • Textile Waste Pick-Up
Skip to Content
  • Language
City of Lynn

City of Lynn

  • Home
  • City Government
    • Departments
      • Animal Control
      • Assessors
      • Chief Financial Officer
      • City Clerk
      • Community Development
      • Comptrollers
      • EDIC
      • Elder Services
      • Elections
      • Emergency Management
      • Fire Department
      • Information Technology (I.T.)
      • Inspectional Services
      • Law
      • Parking Department
      • Parks & Recreation
      • Personnel
      • Planning Department
      • Police
      • Public Health
      • Public Library
      • Public Works
      • Purchasing
      • Treasurer/Collector
      • Veterans Services
      • Harbormaster and Shellfish Constable
    • Lynn Public Schools
    • Mayor's Office
      • Mayor's Staff
      • Newsletter
      • Office Hours
      • DEI
      • Initiatives
      • Community Resources
      • Social Media
    • City Council
      • City Council Members
      • Committees
      • Meeting Information
      • Contact
      • Archive
      • Interpretation/Translation Services
    • Boards & Commissions
      • Affordable Housing Trust Fund
      • Board of Health
      • Charter Review Committee
      • Citizens Advisory Board
      • Conservation Commission
      • Council on Aging
      • Cultural Council
      • Disability Commission
      • Election Commission
      • Emergency Planning
      • Food Policy Council
      • Grand Army of the Republic (GAR) Trustees
      • Historical Commission
      • Human Rights Commission
      • LHAND Commission
      • Licensing Commission
      • Lynn Calm Team Community Advisory Committee
      • Lynn Community Television
      • Municipal Finance
      • Off-Street Parking
      • Park Commission
      • Pine Grove Cemetery Commission
      • Planning Board
      • Public Arts Commission
      • Public Library Trustees
      • Retirement Board
      • Stadium Commission
      • Traffic Commission
      • Wage Theft Advisory Committee
      • Water & Sewer Commission
      • Zoning Board of Appeals
      • Cable Television Advisory Committee
      • Residency Compliance Commission
    • American Rescue Plan Act (ARPA)
      • Lynn's ARPA Dashboard
      • ARPA Funded Projects
      • For Subrecipients
      • For City Departments
      • Closed Bids
    • Diversity, Equity, & Inclusion
      • The Lynn CALM Team
      • The REAL Team
      • Language Access
    • Non-Discrimination Policies
  • Community
    • Accessibility
    • Gannon Municipal Golf Course
    • High Rock Tower Reservation
    • King's Beach
      • Steering Committee
      • Initiatives
      • Email List
    • Lynn Housing Authority & Neighborhood Development
    • Lynn Water & Sewer Commission
    • Lynn Public Library
    • Municipal Meetings
      • Assessors
      • Community Television Inc.
      • Citizen's Advisory
      • City Council
      • Committee of the Whole
      • Conservation Commission
      • Council On Aging
      • CMCC | CDC Boards
      • Cultural Council
      • Disability Commission
      • EDIC
      • Emergency Management
      • Emergency Planning
      • Board of Health
      • Historical Commission
      • Housing Authority
      • Human Rights Commission
      • Library and GAR Trustees
      • Licensing Commission
      • Lynn PAC
      • Pickering Building Committee
      • Municipal Finance Corp.
      • Off Street Parking
      • Park Commission
      • Pine Grove Commission
      • Planning Board
      • Public Arts Commission
      • Public Hearings | Other
      • Residency Compliance
      • Retirement Board
      • School Committee
      • Stadium Commission
      • Traffic Commission
      • Water Sewer Commision
      • Zoning Board of Appeals
      • Food Policy Council
    • RAVE/Smart 911
    • Report an Issue
    • Resident Resources
    • Rodent Control
    • Street Sweeping
    • Trash & Recycling Information
    • Yard Sale Listings
  • How Do I?
    • Pay
      • Parking Ticket
      • A Bill
    • Apply/Register
      • For a Job
      • To a Board/Commission
      • For a Building Permit
      • For a Marriage Certificate
      • For a Senior Tax Exemption
      • For Canning
      • To Vote
    • Request
      • Animal Control
      • Trash Pick-Up
      • Trash/Recycling Barrel Repair
      • Vote by Mail Ballot
      • Public Records
      • Textile Waste Pick-Up
Menu
MENU
  • Home
  • City GovernmentCity Government
    • DepartmentsDepartments
      • Animal Control
      • Assessors
      • Chief Financial Officer
      • City Clerk
      • Community Development
      • Comptrollers
      • EDIC
      • Elder Services
      • Elections
      • Emergency Management
      • Fire Department
      • Information Technology (I.T.)
      • Inspectional Services
      • Law
      • Parking Department
      • Parks & Recreation
      • Personnel
      • Planning Department
      • Police
      • Public Health
      • Public Library
      • Public Works
      • Purchasing
      • Treasurer/Collector
      • Veterans Services
      • Harbormaster and Shellfish Constable
    • Lynn Public Schools
      • Mayor's OfficeMayor's Office
        • Mayor's Staff
        • Newsletter
        • Office Hours
        • DEI
        • Initiatives
        • Community Resources
        • Social Media
      • City CouncilCity Council
        • City Council Members
        • Committees
        • Meeting Information
        • Contact
        • Archive
        • Interpretation/Translation Services
      • Boards & CommissionsBoards & Commissions
        • Affordable Housing Trust Fund
        • Board of Health
        • Charter Review Committee
        • Citizens Advisory Board
        • Conservation Commission
        • Council on Aging
        • Cultural Council
        • Disability Commission
        • Election Commission
        • Emergency Planning
        • Food Policy Council
        • Grand Army of the Republic (GAR) Trustees
        • Historical Commission
        • Human Rights Commission
        • LHAND Commission
        • Licensing Commission
        • Lynn Calm Team Community Advisory Committee
        • Lynn Community Television
        • Municipal Finance
        • Off-Street Parking
        • Park Commission
        • Pine Grove Cemetery Commission
        • Planning Board
        • Public Arts Commission
        • Public Library Trustees
        • Retirement Board
        • Stadium Commission
        • Traffic Commission
        • Wage Theft Advisory Committee
        • Water & Sewer Commission
        • Zoning Board of Appeals
        • Cable Television Advisory Committee
        • Residency Compliance Commission
      • American Rescue Plan Act (ARPA)American Rescue Plan Act (ARPA)
        • Lynn's ARPA Dashboard
        • ARPA Funded Projects
        • For Subrecipients
        • For City Departments
        • Closed Bids
      • Diversity, Equity, & InclusionDiversity, Equity, & Inclusion
        • The Lynn CALM Team
        • The REAL Team
        • Language Access
      • Non-Discrimination Policies
      • CommunityCommunity
        • Accessibility
          • Gannon Municipal Golf Course
            • High Rock Tower Reservation
              • King's BeachKing's Beach
                • Steering Committee
                • Initiatives
                • Email List
              • Lynn Housing Authority & Neighborhood Development
                • Lynn Water & Sewer Commission
                  • Lynn Public Library
                    • Municipal MeetingsMunicipal Meetings
                      • Assessors
                      • Community Television Inc.
                      • Citizen's Advisory
                      • City Council
                      • Committee of the Whole
                      • Conservation Commission
                      • Council On Aging
                      • CMCC | CDC Boards
                      • Cultural Council
                      • Disability Commission
                      • EDIC
                      • Emergency Management
                      • Emergency Planning
                      • Board of Health
                      • Historical Commission
                      • Housing Authority
                      • Human Rights Commission
                      • Library and GAR Trustees
                      • Licensing Commission
                      • Lynn PAC
                      • Pickering Building Committee
                      • Municipal Finance Corp.
                      • Off Street Parking
                      • Park Commission
                      • Pine Grove Commission
                      • Planning Board
                      • Public Arts Commission
                      • Public Hearings | Other
                      • Residency Compliance
                      • Retirement Board
                      • School Committee
                      • Stadium Commission
                      • Traffic Commission
                      • Water Sewer Commision
                      • Zoning Board of Appeals
                      • Food Policy Council
                    • RAVE/Smart 911
                      • Report an Issue
                        • Resident Resources
                          • Rodent Control
                            • Street Sweeping
                              • Trash & Recycling Information
                                • Yard Sale Listings
                                  • Summer Youth Employment Program
                                    • Lynn Interim Station & Ferry
                                    • How Do I?How Do I?
                                      • PayPay
                                        • Parking Ticket
                                        • A Bill
                                      • Apply/RegisterApply/Register
                                        • For a Job
                                        • To a Board/Commission
                                        • For a Building Permit
                                        • For a Marriage Certificate
                                        • For a Senior Tax Exemption
                                        • For Canning
                                        • To Vote
                                      • RequestRequest
                                        • Animal Control
                                        • Trash Pick-Up
                                        • Trash/Recycling Barrel Repair
                                        • Vote by Mail Ballot
                                        • Public Records
                                        • Textile Waste Pick-Up
                                    Search
                                    {1}
                                    ##LOC[OK]##
                                     
                                     
                                    City of Lynn » City Government » Departments » Personnel » Employment Benefits » Health Insurance » Forms
                                    Skip Sidebar Navigation
                                    Side Navigation
                                    Prescription Drug Coverage / MaxorPlus
                                    Medicare Enhanced/United Healthcare RX
                                    Forms
                                    Health Resources
                                    Monthly Calendar
                                    Last item for navigation

                                    Forms

                                    HPHC Group Enrollment form 2023

                                    Termination of Health Insurance Affidavit


                                    City of Lynn
                                    City of Lynn
                                    City of Lynn
                                    City of Lynn
                                    3 City Hall Square
                                    Lynn, Massachusetts 01901
                                    Mon. Wed. & Thurs. 8:30 AM to 4:00 PM
                                    Tuesday 8:30 AM to 8:00 PM
                                    Friday 8:30 AM to 12:30 PM
                                    (781) 598-4000
                                    Website by Civiclive. © 2025 Civiclive. All rights reserved.
                                    Login