AFSCME (General Service) Employee Benefits

Categories:

​The City of Salem offers their career employees represented by the American Federation of State, County and Municipal Employees (AFSCME) a generous benefits package.

2019 AFSCME Health Plan Options and Premium Rates176 KBafscme-health-plan-options-and-rates.pdf
2019 COBRA, Retiree Health Insurance Premium Rates81 KBcobra-retiree-health-insurance-premium-rates.pdf
2019 HDHP Summary of Benefits Coverage (SBC)1058 KBhdhp-sbc.pdf
2019 Health Savings Account (HSA) Contribution Summary184 KBhealth-savings-account-hsa-contribution-summary.pdf
2019 Kaiser Summary of Benefits Coverage (SBC)492 KBkaiser-sbc.pdf
2019 PPO Summary of Benefits Coverage (SBC)1079 KBppo-sbc-all-other-groups.pdf
2020 AFSCME Health Plan Options and Employee Rates175 KB2020-afscme-health-plan-options-and-rates.pdf
2020 COBRA Retiree Health Insurance Premium Rates83 KB2020-cobra-retiree-health-insurance-premium-rates.pdf
2020 HDHP Summary of Benefits Coverage (SBC)543 KB2020-hdhp-sbc.PDF
2020 Health Insurance Premiums with Employer Rates142 KB2020-health-insurance-premiums-with-employer-rates.pdf
2020 Kaiser Summary of Benefits (SBC)500 KB2020-kaiser-sbc.pdf
2020 PPO Summary of Benefits Coverage (SBC)573 KB2020-ppo-sbc-all-other-groups.PDF
Domestic Partner Policy108 KBdomestic-partner-policy.pdf
Flyer - How the HDHP and HSA Work279 KBhow-the-hdhp-and-hsa-work-flyer.pdf
HDHP Plan Document1512 KBhdhp-plan-document.pdf
Health Hub Health Clinic Flyer223 KBhealth-hub-health-clinic-flyer.pdf
Health Insurance Opt-Out Incentive Eligibility Requirements174 KBhealth-insurance-opt-out-incentive-eligibility-requirements.pdf
Health Insurance Premiums with Employer Rates272 KBhealth-insurance-premiums-with-employer-rates.pdf
HRAVEBA - Plan Document367 KBhraveba-plan-document.pdf
HRAVEBA Contribution Summary90 KBhra-veba-contribution-summary.pdf
HRAVEBA Plan Brochure3263 KBhra-veba-plan-brochure.pdf
HRAVEBA Plan Summary 307 KBhra-veba-plan-summary.pdf
HSA - Frequently Asked Questions Flyer1262 KBhsa-frequently-asked-questions-flyer.pdf
Kaiser Plan Document1327 KBkaiser-medical-plan-document.pdf
PPO Plan Document - AFSCME1502 KBppo-plan-document-afscme.pdf
Summary of Benefits Coverage - Glossary90 KBsbc-glossary.pdf
2020 Willamette Dental Summary of Benefits102 KB2020-dental-summary-willamette.pdf
Delta Dental Moda Plans - Summary of Benefits137 KBdental-summary-moda-delta-dental.pdf
Incentive Dental Plan Document1606 KBdental-plan-document-incentive.pdf
Traditional Dental Plan Document1606 KBdental-plan-document-traditional.pdf
Willamette Dental - Summary of Benefits218 KBdental-summary-willamette.pdf
Willamette Dental Enrollment Guide2414 KBdental-enrollment-guide-willamette-dental.PDF
Willamette Dental Plan Document618 KBdental-plan-document-willamette.pdf
Willamette Dental Provider List70 KBdental-provider-list-willamette.pdf
Vision Plans303 KBvision-plans-500.pdf

Cascade Centers - EAP (800) 433-2320

Home Ownership Program320 KBeap-flyer-home-ownership-program.pdf
Hubbub Wellness1333 KBeap-flyer-hubbub-wellness.pdf
ID Theft Services521 KBeap-flyer-id-theft-services.pdf
Life Coaching830 KBeap-flyer-life-coaching.pdf
Lifepilot417 KBeap-flyer-lifepilot.pdf
Military Assistance1777 KBeap-flyer-military-assistance.pdf
Online Resources1268 KBeap-resources-online.pdf
Resource Retrieval252 KBeap-flyer-eap-resource-retrieval.pdf
Summary of Services114 KBeap-summary-of-services.pdf
Wills143 KBeap-flyer-wills.pdf
2020 Open Enrollment Flexible Spending Account (FSA) Enrollment Form137 KB2020-open-enrollment-flexible-spending-account-enrollment-form.pdf
2020 Open Enrollment Flexible Spending Limited Purpose Enrollment Form95 KB2020-open-enrollment-flexible-spending-limited-purpose-enrollment-form.pdf
Flexible Spending Accounts Frequently Asked Questions Flyer424 KBflexible-spending-accounts-frequently-asked-questions-flyer.pdf
Flexible Spending Accounts Plan Document436 KBflexible-spending-accounts-plan-document.pdf
Life - ADD AFSCME Policy130 KBlifeadd-policy-afscme.pdf
LTD - AFSCME Policy117 KBltd-policy-afscme.pdf
Additional AD&D Policy70 KBadditional-add-policy.pdf
Additional AD&D Summary36 KBadditional-add-summary.pdf
Additional Life Policy164 KBadditional-life-policy.pdf
Additional Life Summary201 KBadditional-life-summary.pdf
Long Term Care - Coverage Outline91 KBlong-term-care-coverage-outline.pdf
Long Term Care - Plan Highlights122 KBlong-term-care-plan-highlights.pdf
Long Term Care - Plan Option Rates30 KBlong-term-care-plan-options-rates.pdf
Long Term Care Enrollment Flyer285 KBlong-term-care-enrollment-flyer.pdf
Voya Unforseeable Emergency Withdrawal Flyer212 KBvoya-unforseeable-emergency-flyer.pdf
Voya 457b Distribution Options Summary3350 KBvoya-distribution-options-summary.pdf
PERS OPSRP New Member Brochure167 KBpers-new-member-brochure.pdf
457 Voya Roth Option10131 KB457-roth-option.pdf
457 Voya Retirement Choice II Booklet510 KB457-retirement-choice-ii-booklet.pdf
457 Voya Online Account Access Instructions1862 KB457-online-account-access-instructions.pdf
457 Voya Core Investment Options191 KB457-core-investment-options.pdf
457 Voya Brokerage Window Option866 KB457-brokerage-window-option.pdf
457 Voya Beneficiary Maintenance Flyer402 KB457-online-beneficiary-maintenance-flyer.pdf
457 Voya Automatic Enrollment Notice - AFSCME and Unrepresented only129 KB457-automatic-enrollment-afscme-and-unrepresented-only.pdf
City of Salem Employee Benefits Contacts List108 KBcity-of-salem-employee-benefits-contacts-list.pdf
Commute Expense Reimbursement Account CERA Policy114 KBcommute-expense-reimbursement-account-cera-policy.pdf
Employee Parking Permits Flyer184 KBemployee-parking-permits-flyer.pdf
Hearing - Health Discount Program Flyer223 KBhearing-health-discount-program-flyer.pdf
Nationwide Pet Insurance FAQ Flyer85 KBnationwide-pet-insurance-faq-flyer.pdf
Nationwide Pet Insurance Flyer951 KBnationwide-pet-insurance-flyer.pdf
Travel Assistance Flyer96 KBtravel-assistance.pdf
2019 Flexible Spending Accounts Enrollment or Waiver Form200 KBflexible-spending-accounts-enrollment-or-waiver-form.pdf
2019 Health Savings Account (HSA) Enrollment Form180 KBhsa-enrollment-form.pdf
2020 Open Enrollment Flexible Spending Account (FSA) Enrollment Form137 KB2020-open-enrollment-flexible-spending-account-enrollment-form.pdf
2020 Open Enrollment Flexible Spending Limited Purpose Enrollment Form95 KB2020-open-enrollment-flexible-spending-limited-purpose-enrollment-form.pdf
2020 Open Enrollment Health Insurance Enrollment, Waiver, Change Form161 KB2020-open-enrollment-health-insurance-enrollment-change-form.pdf
2020 Open Enrollment Health Savings Account (HSA) Enrollment Form143 KB2020-open-enrollment-health-savings-account-enrollment-form.pdf
Additional AD&D Insurance Enrollment Beneficiary Form164 KBadditional-add-insurance-enrollment-beneficiary-form.pdf
Additional Life Insurance Enrollment Beneficiary Form69 KBadditional-life-insurance-enrollment-beneficiary-form.pdf
Birth Certificate Verification form201 KBbirth-certificate-verification-form.pdf
City Paid Life and AD&D Insurance Beneficiary Form289 KBcity-paid-life-and-add-insurance-beneficary-form.pdf
Commute Expense Reimbursement Account CERA Claim Form124 KBcommute-expense-reimbursement-account-cera-claim-form.pdf
Commute Expense Reimbursement Account CERA Enrollment form100 KBcommute-expense-reimbursement-account-cera-enrollment-form.pdf
Disabled Dependent Certification form459 KBdisabled-dependent-certification-form.pdf
Domestic Partner Affidavit form89 KBdomestic-partner-affidavit-form.pdf
Domestic Partner Termination form72 KBdomestic-partner-termination-form.pdf
EBMS - Medical and Vision Claim Form240 KBebms-medical-vision-claim-form.pdf
Electronic Disclosure Form135 KBelectronic-disclosure-form.pdf
Employee Address or Emergency Contact Change form86 KBemployee-address-change-form.pdf
Employee or Dependent Name Change form158 KBhr-063-employee-or-dependent-name-change-form.pdf
Employee Request for Accomodation Form - ADA1240 KBhr-034-employee-request-for-accommodation-form-ada.pdf
Flexible Spending Accounts Claim Form55 KBflexible-spending-accounts-claim-form.pdf
Flexible Spending Accounts Mid Year Change Form118 KBflexible-spending-accounts-mid-year-change-form.pdf
Health Care Provider - Serious (Family)60 KBhr-020-protected-leave-family-serious-cert.pdf
Health Care Provider - Serious (Self)143 KBhr-019-protected-leave-health-care-provider-serious-self.pdf
Health Hub Service Agreement Form159 KBhealth-hub-service-agreement-form.pdf
Health Insurance Coordination of Benefits137 KBhealth-insurance-coordination-of-benefits-form.pdf
Health Insurance Enrollment, Waiver, Change Form162 KBhealth-insurance-enrollment-form.pdf
Health Insurance Opt-Out Waiver Incentive Form137 KBhealth-insurance-opt-out-waiver-incentive-form.pdf
Incident Report Form571 KBincident-report-form.pdf
Life and Long Term Disability Form314 KBlife-and-long-term-disability-form.pdf
Medical Provider Inquiry Form - ADA1240 KBhr-035-medical-provider-inquiry-form-ada.pdf
Military Exigency Leave61 KBhr-021-protected-leave-military-extgency-leave.pdf
Military Family Leave68 KBhr-022-protected-leave-serious-military-family.pdf
Optum RX Mail Order Prescription Form497 KBoptum-rx-mail-order-prescription-form.pdf
Optum RX Member Reimbursement Form101 KBoptum-rx-member-reimbursement-form.pdf
PERS IAP Beneficiary Form634 KBpers-iap-beneficiary-form.pdf
PERS Tier 1 or Tier 2 Beneficiary Form1239 KBpers-tier-1-or-tier-2-beneficiary-form.pdf
Protected Leave Application117 KBhr-017-protected-leave-application.pdf
Release of Health Information104 KBhr-018-protected-leave-release-of-health-information.pdf
Release to Return to Work48 KBhr-026-release-to-return-to-work.pdf
Veteran Military Caregiving Leave120 KBhr-023-protected-leave-veteran-care.pdf
Voya - EZ Enrollment Form482 KBdeferred-comp-ez-enrollment-form.pdf
Voya - Final Paycheck Deferral Form97 KBvoya-final-paycheck-deferral-form.pdf
Voya - Holiday Cash Out Deferral Form100 KBvoya-holiday-cash-out-deferral-form.pdf
Voya Enrollment form85 KBdeferred-comp-long-enrollment-form.pdf

Notices

Cobra - General Notice
Health plan coverage continuation rights under COBRA.
132 KB
Health Plan Annual Required Notices
Health plans are required to provide certain notices to eligible health plan members.
226 KB
HIPPA - Notice of Privacy Practices
172 KB
Marketplace Coverage Options Notice
170 KB

Contact us

Michele BennettHuman Resources ManagerCarrie WagnerHuman Resources SpecialistHuman Resources Department
Monday–Friday
8:00 a.m.–5:00 p.m.
555 Liberty ST SE RM 225
Salem OR 97301
Phone: 
503-588-6162Human Resources main line503-589-2085Carrie Wagner's direct line