Employees and Retirees
The health and safety of active employees and retirees is of the utmost importance to the City of Lebanon. In response to the coronavirus (COVID-19) outbreak, City Hall has closed its offices to all public visitors, until further notice. Our normal business operations are continuing, and the Human Resources Department is available by phone at 603-448-0683 or email at email@example.com to assist employees and retirees with any questions regarding their benefits.
If you need to make any changes to your health benefits due to a qualifying event (marriage/divorce/birth/death), you will need to complete a new HealthTrust Medical and/or Dental Membership Change form and submit to Human Resources prior to the effective date of the change. Effective date of health benefits changes is the first of the month following the date of event.
- Address Change (City of Lebanon)
- Childcare Request Form (City of Lebanon)
- Personal Information Change Form (New Hampshire Retirement System)
- Beneficiary Form (New Hampshire Retirement System)
- Federal W-4 (IRS)
- State of Vermont W-4VT
- Direct Deposit Form (City of Lebanon)
These forms can be submitted electronically by emailing them to firstname.lastname@example.org. If you wish to speak with someone in the Human Resources Department, please call 603-448-0683, Monday-Friday, between 8:00 – 4:30.
If you are a retiree turning 65, or your spouse is turning 65, you will need to convert to the Medicare Supplemental plan (Medicomp Three) with or without prescription coverage offered by HealthTrust. The effective date will be the first of the month in which age 65 is attained.
To transition to the Medicomp plan for the individual attaining age 65:
- Retiree Medical and/or Dental Application and Change form
- A copy of Medicare health insurance Part A and Part B card
- Annuity Deduction Authorization for Medical and Dental Benefits form
If you are on a two-person or family plan, any remaining covered members under age 65, will continue to be covered on the current health plan. However, a Medical and/or Dental Membership Change Form, will need to be completed listing the members to be covered on that plan.
The completed forms can be returned to the Human Resources Department by email to email@example.com; by fax at 603-216-3727; mail to 51 North Park Street, Lebanon, NH 03766 or you can mail the forms directly to HealthTrust at PO Box 617, Concord, NH 03302.
Please note that our physical location has temporarily relocated to 20 West Park Street, Lebanon, NH.