AFSCME (General Service) Employee Benefits

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

2020 EBMS Plan Document Amendments461 KBebms-plan-document-amendments.pdf
AFSCME Health Plan Options and Employee Rates175 KB2020-afscme-health-plan-options-and-rates.pdf
COBRA, Retiree Health Insurance Premium Rates81 KBcobra-retiree-health-insurance-premium-rates.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
HDHP Summary of Benefits Coverage (SBC)543 KB2020-hdhp-sbc.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 Rates142 KB2020-health-insurance-premiums-with-employer-rates.pdf
Health Savings Account (HSA) Contribution Summary94 KBhealth-savings-account-hsa-contribution-summary.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
Kaiser Summary of Benefits (SBC)500 KB2020-kaiser-sbc.pdf
PPO Plan Document - AFSCME1502 KBppo-plan-document-afscme.pdf
PPO Summary of Benefits Coverage (SBC)573 KB2020-ppo-sbc-all-other-groups.PDF
Summary of Benefits Coverage - Glossary90 KBsbc-glossary.pdf
Delta Dental Moda Plans - Summary of Benefits137 KBdental-summary-moda-delta-dental.pdf
Incentive Dental Plan Document2321 KBdental-plan-document-incentive.pdf
Traditional Dental Plan Document2259 KBdental-plan-document-traditional.pdf
Willamette Dental Enrollment Guide2414 KBdental-enrollment-guide-willamette-dental.PDF
Willamette Dental Plan Document346 KBdental-plan-document-willamette.pdf
Willamette Dental Provider List70 KBdental-provider-list-willamette.pdf
Willamette Dental Summary of Benefits102 KB2020-dental-summary-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
Flexible Spending Accounts Frequently Asked Questions Flyer227 KBflexible-spending-accounts-frequently-asked-questions-flyer.pdf
Flexible Spending Accounts Plan Description160 KBflexible-spending-accounts-plan-description.pdf
Flexible Spending Accounts Plan Document260 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 Policy107 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
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 Form113 KBcommute-expense-reimbursement-account-cera-claim-form.pdf
Commute Expense Reimbursement Account CERA Enrollment form92 KBcommute-expense-reimbursement-account-cera-enrollment-form.pdf
Covid Protected Leave Application72 KBhr-017-covid-protected-leave-application.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 form90 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 (FSA) Enrollment or Waiver Form144 KBflexible-spending-accounts-enrollment-or-waiver-form-2020.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 Form161 KBhealth-insurance-enrollment-form.pdf
Health Insurance Opt-Out Waiver Incentive Form137 KBhealth-insurance-opt-out-waiver-incentive-form.pdf
Health Savings Account (HSA) Enrollment Form144 KBhsa-enrollment-form-2020.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 Form802 KBpers-iap-beneficiary-form.pdf
PERS Tier 1 or Tier 2 Beneficiary Form805 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 Form590 KBdeferred-comp-ez-enrollment-form.pdf
Voya - Final Paycheck Deferral Form97 KBvoya-final-paycheck-deferral-form.pdf
Voya - Holiday Cash Out Deferral Form90 KBvoya-holiday-cash-out-deferral-form.pdf
Voya Enrollment form85 KBdeferred-comp-long-enrollment-form.pdf
Wellness Committee Supervisor Approval Form100 KBwellness-committee-supervisor-approval-form.pdf

Notices

Cobra - General Notice
Health Plan Annual Required Notices
HIPPA - Notice of Privacy Practices
Marketplace Coverage Options Notice

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