Boston Medical Center – Benefits

Your Forms:


+ Personal Information

  • Membership Form
  • Update Form
  • Affidavit – If you cannot locate the marriage certificate or birth certificate(s), you can submit this affidavit in its place. The affidavit must be notarized.

Membership Form & Update Form


+ Disability

For purposes of our disability benefits, “disabled” means you can no longer perform the duties of your occupation due to accidental bodily injury, sickness, or a related medical condition, including pregnancy or childbirth. You must also be under the care of a licensed provider as defined by the state in which you work.

2021 Massachusetts Paid Family And Medical Leave (MPFML) – Visit mass.gov/PFML for more information.

  • Short-Term Disability (STD) Benefits Claim Form
    • Coverage begins on the eighth (8th) day of your disability. The maximum benefit payable is 60% of your weekly salary, up to $692 per week, for up to 26 weeks. See the Summary Plan Description (SPD) for more details.
    • If you are going out on a disability leave, contact your employer as soon as possible.
  • Long-Term Disability (LTD) Benefits Claim Form
    • The LTD plan pays you 60% of your monthly salary, up to a maximum of $3,500 per month. LTD benefits typically start if you are still disabled after 26 continuous weeks. For detailed information on Long-Term Disability see the Guardian Certificate.
    • When you terminate employment, you will have the option to convert this benefit to an individual policy, subject to certain conditions.
  • INSMED Portable Disability Coverage – Policies offered to you without any medical underwriting requirements or exams.

+ Education

  • Participants are eligible for up to $3,000 in reimbursement per plan year (July 1-June 30) to cover expenses related to attend a U.S. patient safety event. You must submit at least 6 weeks prior to the conference date.
  • Library Funds Request

+ Childcare

Backup Childcare Benefit (CARE.COM)


+ Employee Assistance Program

Attention: In compliance with HIPAA regulations, we are using a secure email portal. Please use benefits@cirseiu.org to send secure emails to the Benefits Office.