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.

AFSCME Health Plan Options and Employee Rates 2022207 KBafscme-health-plan-options-and-rates.pdf
COBRA, Retiree Health Insurance Premium Rates 202282 KBcobra-retiree-health-insurance-premium-rates.pdf
Domestic Partner Policy108 KBdomestic-partner-policy.pdfdomestic-partner-policy.pdf Checked Out To: Carrie Wagner
EBMS 2022 Out of Network balance bill assistance flyer91 KBebms-oon-flyer-fair.pdf
HDHP and HSA FAQ Flyer279 KBhow-the-hdhp-and-hsa-work-flyer.pdf
HDHP Plan Document2323 KBhdhp-plan-document.pdf
HDHP Summary of Benefits Coverage (SBC) 2022321 KBhdhp-sbc.pdf
Health Hub Health Clinic Flyer3346 KBhealth-hub-health-clinic-flyer.pdf
Health Hub Margo Turney Bio Flyer2995 KBhealth-hub-provider-bio-flyer.pdf
Health Hub Saving Money Flyer381 KBhealth-hub-saving-money-flyer.pdf
Health Insurance Opt-Out Waiver Incentive Eligibility Requirements125 KBhealth-Insurance-opt-out-incentive-eligibility-requirements.pdf
Health Insurance Premiums with Total Premium Rates 194 KBhealth-insurance-premiums-all-employee-groups.pdf
Health Savings Account (HSA) Contribution Summary118 KBhealth-savings-account-hsa-contribution-summary.pdf
HRAVEBA Contribution Summary114 KBhra-veba-contribution-summary.pdf
HRAVEBA Plan Document367 KBhraveba-plan-document.pdf
HRAVEBA Plan Summary 307 KBhra-veba-plan-summary.pdf
HRAVEBA Summary of Benefits Coverage (SBC)562 KBhraveba-sbc.pdf
Kaiser Permanente Alternative Care flyer125 KBkaiser-alternative-care-flyer.pdf
Kaiser Permanente Dependent Out of Area flyer96 KBKaiser-dependent-out-of-area-flyer.pdf
Kaiser Permanente Emergency/Urgent Care Travel flyer4203 KBkaiser-emergency-urgent-care-travel-flyer.pdf
Kaiser Permanente Gender Pathways Clinic flyer105 KBkaiser-gender-pathways-clinic-flyer.pdf
Kaiser Permanente Mental Health and Wellness services flyer94 KBkaiser-mental-health-wellness-flyer.pdf
Kaiser Permanente Online Access flyer127 KBkaiser-online-access-flyer.pdf
Kaiser Permanente Plan Document911 KBkaiser-medical-plan-document.pdf
Kaiser Permanente Plan Summary 202246 KBkaiser-summary.pdf
Kaiser Permanente Quick Access and Telehealth flyer144 KBkaiser-quick-access-telehealth-flyer.pdf
Kaiser Permanente Summary of Benefits Coverage (SBC) 2022452 KBkaiser-sbc.pdf
Kaiser Permanente Welcome flyer77 KBkaiser-welcome-flyer.pdf
PPO Plan Document - AFSCME2313 KBppo-plan-document-afscme.pdf
PPO Summary of Benefits Coverage (SBC) 2022329 KBppo-sbc.pdf
Summary of Benefits Coverage Glossary90 KBsbc-glossary.pdf
Welldyne ACA Preventaitve Care covered meds list264 KBwelldyne-rx-aca-preventive-covered-meds_list.pdf
Welldyne COB Overview flyer155 KBwelldyne-rx-cob-overview-flyer.pdf
Welldyne COVID At-Home Test Coverage FAQ flyer144 KBwelldyne-rx-faq-covid-test-flyer.pdf
Welldyne Frequently Asked Questions flyer186 KBwelldyne-frequently-asked-questions-flyer.pdf
Welldyne Mail Order Pharmacy flyer117 KBwelldyne-mail-order-pharmacy-flyer.pdf
WellDyne prescription introduction flyer456 KBwelldyne-rx-intro-flyer.pdf
WellDyne prescription online member registration flyer444 KBwelldyne-rx-online-registration-flyer.pdf
Welldyne Prior Authorization flyer384 KBwelldyne-prior-authorization-flyer.pdf
Welldyne Retail Pharmacy Network List157 KBwelldyne-rx-network-chain-list.pdf
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Moda Delta Dental Incentive Dental Plan Document2215 KBdental-plan-document-incentive.pdf
Moda Delta Dental Incentive Plan Summary 1698 KBdental-moda-incentive-plan-summary.pdf
Moda Delta Dental Traditional (Constant) Dental Plan Document2217 KBdental-plan-document-traditional.pdf
Moda Delta Dental Traditional (Constant) Plan Summary1318 KBdental-moda-traditional-plan-summary.pdf
Willamette Dental Plan Document346 KBdental-plan-document-willamette.pdf
Willamette Dental Plan Summary72 KBdental-summary-willamette-dental.pdf
Vision Plan Summary $500 Plan93 KBvision-plans-500.pdf
Vision Plan Summary Traditional Plan (Closed to most new enrollment)81 KBvision-plan-traditional.pdf

Cascade Centers - EAP (800) 433-2320

Advantage Home Plus Home Ownership Program12327 KBeap-flyer-home-ownership-program.pdf
Advantage Home Plus Home Ownership Program Services Flyer1092 KBeap-home-ownership-program.pdf
EAP Fertility Health and Family Building flyer1191 KBeap-fertility-health-and-family-building.pdf
EAP Financial Coaching Flyer1184 KBeap-financial-coaching.pdf
EAP Life Balance Flyer897 KBeap-life-balance.pdf
EAP Mental Health Awareness Flyer320 KBeap-mental-health-awareness.pdf
EAP Resources for life Flyer800 KBeap-resources-for-life.pdf
EAP Summary of Services Flyer40 KBeap-summary-of-services.pdf
2022 Open Enrollment Flexible Spending Account (FSA) Enrollment form170 KBopen-enrollment-flexible-spending-accounts-enrollment-form.pdfopen-enrollment-flexible-spending-accounts-enrollment-form.pdf Checked Out To: Carrie Wagner
2022 Open Enrollment Flexible Spending Account (FSA) Limited Purpose Enrollment form112 KBopen-enrollment-flexible-spending-limited-purpose-enrollment-form.pdfopen-enrollment-flexible-spending-limited-purpose-enrollment-form.pdf Checked Out To: Carrie Wagner
EBMS Flexible Spending Account Online Claim Submittal Instructions5090 KBflexible-spending-accounts-online-claim-submittal-instructions.pdf
EBMS Flexible Spending Accounts Frequently Asked Questions Flyer83 KBflexible-spending-accounts-frequently-asked-questions-flyer.pdf
EBMS Flexible Spending Accounts Reimbursement Direct Deposit Instructions1412 KBflexible-spending-accounts-reimbursement-direct-deposit-instructions.pdf
Flexible Spending Accounts Plan Description160 KBflexible-spending-accounts-plan-description.pdf
Flexible Spending Accounts Plan Document396 KBflexible-spending-accounts-plan-document.pdf
Life - ADD AFSCME Policy130 KBlifeadd-policy-afscme.pdf
LTD - AFSCME Policy127 KBltd-policy-afscme.pdf
Hartford Additional AD&D Policy70 KBadditional-add-policy.pdf
Hartford Additional AD&D Summary36 KBadditional-add-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
Standard Additional Life Policy164 KBadditional-life-policy.pdf
Standard Additional Life Summary201 KBadditional-life-summary.pdf
PERS Tier 1 or Tier 2 Pre-Retirement Guide1777 KBpers-tier1-tier2-preretirement-guide.pdf
PERS OPSRP Pre-Retirement Guide481 KBpers-opsrp-preretirement-guide.pdf
PERS OPSRP New Member Brochure167 KBpers-new-member-brochure.pdf
PERS Online Member Services account flyer1527 KBpers-online-member-services-account-flyer.pdf
PERS Benefit Comparisons802 KBpers-benefit-comparison.pdf
COBRA, Retiree Health Insurance Premium Rates 202282 KBcobra-retiree-health-insurance-premium-rates.pdf
457 Voya Unforseeable Emergency Withdrawal Flyer212 KBvoya-unforseeable-emergency-flyer.pdf
457 Voya Roth Option10131 KB457-roth-option.pdf
457 Voya Retirement Choice II Booklet510 KB457-retirement-choice-ii-booklet.pdf
457 Voya Overview1238 KB457-overview.pdf
457 Voya Online Account Access Instructions1175 KB457-online-account-access-instructions.pdf
457 Voya Distribution Options Summary3350 KBvoya-distribution-options-summary.pdf
457 Voya Core Investment Options191 KB457-core-investment-options.pdf
457 Voya Contribution Limits 2022372 KB457-contribution-limits.pdf
457 Voya Brokerage Window Option866 KB457-brokerage-window-option.pdf
457 Voya Beneficiary Designation Flyer677 KB457-online-beneficiary-maintenance-flyer.pdf
457 Voya Automatic Enrollment Notice SPEU new hire72 KB457-automatic-enrollment-notice-speu.pdf
457 Voya Automatic Enrollment Notice AFSCME and Unrepresented new hire129 KB457-automatic-enrollment-afscme-and-unrepresented-only.pdf
457 Voya and Roth Savings Compare60 KB457-roth-savings-compare.pdf
Amplifon Hearing Benefit Program Flyer (Unrepresented EBMS enrolled only)1223 KBhearing-health-benefit-program-flyer.pdf
Amplifon Hearing Discount Program Flyer873 KBhearing-health-discount-program-flyer.pdf
City of Salem Employee Benefits Contacts List127 KBcity-of-salem-employee-benefits-contacts-list.pdf
Commute Expense Reimbursement Account CERA Policy89 KBcommute-expense-reimbursement-account-cera-policy.pdf
Employee Parking Permits Flyer184 KBemployee-parking-permits-flyer.pdf
Nationwide Pet Insurance FAQ Flyer85 KBnationwide-pet-insurance-faq-flyer.pdf
Nationwide Pet Insurance Flyer951 KBnationwide-pet-insurance-flyer.pdf
Travel Assistance Flyer975 KBtravel-assistance.pdf
2022 Open Enrollment Flexible Spending Account (FSA) Enrollment form170 KBopen-enrollment-flexible-spending-accounts-enrollment-form.pdfopen-enrollment-flexible-spending-accounts-enrollment-form.pdf Checked Out To: Carrie Wagner
2022 Open Enrollment Flexible Spending Account (FSA) Limited Purpose Enrollment form112 KBopen-enrollment-flexible-spending-limited-purpose-enrollment-form.pdfopen-enrollment-flexible-spending-limited-purpose-enrollment-form.pdf Checked Out To: Carrie Wagner
2022 Open Enrollment Health Insurance Opt-Out Waiver Incentive form154 KBopen-enrollment-health-insurance-opt-out-waiver-incentive-form.pdfopen-enrollment-health-insurance-opt-out-waiver-incentive-form.pdf Checked Out To: Carrie Wagner
2022 Open Enrollment Health Savings Account (HSA) Enrollment form147 KBopen-enrollment-health-savings-account-enrollment-form.pdfopen-enrollment-health-savings-account-enrollment-form.pdf Checked Out To: Carrie Wagner
ADA Employee Request for Accommodation form1240 KBhr-034-employee-request-for-accommodation-form-ada.pdf
ADA Medical Provider Inquiry form1240 KBhr-035-medical-provider-inquiry-form-ada.pdf
Birth Certificate Verification form201 KBbirth-certificate-verification-form.pdf
Commute Expense Reimbursement Account (CERA) Claim form108 KBcommute-expense-reimbursement-account-cera-claim-form.pdf
Commute Expense Reimbursement Account (CERA) Enrollment form90 KBcommute-expense-reimbursement-account-cera-enrollment-form.pdf
Covid Protected Leave Application72 KBhr-017-covid-protected-leave-application.pdf
Dependent Name Change Form86 KBdependent-name-change-form.pdf
Disabled Dependent Health Insurance Certification form459 KBdisabled-dependent-certification-form.pdf
Domestic Partner Health Insurance Affidavit form89 KBdomestic-partner-affidavit-form.pdf
Domestic Partner Health Insurance 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 Name Change Form99 KBhr063-employee-name-change-form.pdf
Flexible Spending Accounts (FSA) Enrollment or Waiver form175 KBflexible-spending-accounts-enrollment-or-waiver-form.pdf
Flexible Spending Accounts (FSA) Mid Year Election Change form101 KBflexible-spending-accounts-mid-year-change-form.pdf
Flexible Spending Accounts (FSA) Reimbursement Claim form62 KBflexible-spending-accounts-claim-form.pdf
Hartford Additional AD&D Insurance Enrollment Beneficiary form164 KBadditional-add-insurance-enrollment-beneficiary-form.pdf
Health Hub Service Agreement form159 KBhealth-hub-service-agreement-form.pdf
Health Insurance Coordination of Benefits form137 KBhealth-insurance-coordination-of-benefits-form.pdf
Health Insurance Enrollment, Waiver, Change form165 KBhealth-insurance-enrollment-form.pdf
Health Insurance Opt-Out Waiver Incentive form154 KBhealth-insurance-opt-out-waiver-incentive-form.pdf
Health Savings Account (HSA) Enrollment form150 KBhealth-savings-account-enrollment-form.pdf
Incident Report form571 KBincident-report-form.pdf
Long Term Disability (LTD) Benefit Claim Packet250 KBltd-benefit-claim-packet.pdf
Military Exigency Leave Application61 KBhr-021-protected-leave-military-extgency-leave.pdf
Military Family Leave Application68 KBhr-022-protected-leave-serious-military-family.pdf
Military Veteran Caregiving Leave Application120 KBhr-023-protected-leave-veteran-care.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
Protected Leave Health Care Provider Certification form - Serious (Family)60 KBhr-020-protected-leave-family-serious-cert.pdf
Protected Leave Health Care Provider Certification form - Serious (Self)143 KBhr-019-protected-leave-health-care-provider-serious-self.pdf
Protected Leave Release of Health Information form104 KBhr-018-protected-leave-release-of-health-information.pdf
Protected Leave Release to Return to Work form48 KBhr-026-release-to-return-to-work.pdf
Standard Additional Life Insurance Enrollment Beneficiary form69 KBadditional-life-insurance-enrollment-beneficiary-form.pdf
Standard Life, ADD, and LTD Enrollment Beneficiary form314 KBlife-and-long-term-disability-form.pdf
Voya Deferred Compensation Enrollment form with investment options85 KBdeferred-comp-long-enrollment-form.pdf
Voya Deferred Compensation EZ Enrollment form565 KBdeferred-comp-ez-enrollment-form.pdf
Voya Deferred Compensation Final Paycheck Deferral form97 KBvoya-final-paycheck-deferral-form.pdf
Voya Deferred Compensation Holiday Cash Out Deferral form87 KBvoya-holiday-cash-out-deferral-form.pdf
Welldyne At-Home COVID Test Reimbursement claim form64 KBwelldyne-rx-athome-covid-test-reimbursement-form.pdf
Welldyne Mail Order Pharmacy Registration form162 KBwelldyne-mail-order-pharmacy-registration-form.pdf
Welldyne Member Reimbursement Claim form180 KBwelldyne-member-reimbursement-form.pdf
Wellness Committee Supervisor Approval form100 KBwellness-committee-supervisor-approval-form.pdf

Notices

Cobra General Notice
Health plan coverage continuation rights under COBRA.
118 KB
Health Plan Annual Required Notices
Health plans are required to provide certain notices to eligible health plan members.
227 KB
HIPPA Notice of Privacy Practices
Notice of the City of Salem's privacy practices related to protected health information.
160 KB
Marketplace Coverage Options Notice
Required notice of Marketplace coverage options.
170 KB

Contact us

Michele BennettHuman Resources ManagerCarrie WagnerHuman Resources Department
Monday–Friday
8:00 a.m.–5:00 p.m.
295 Church ST SE Suite 210
Salem OR 97301
Phone: 
503-588-6162Human Resources main line503-589-2085Carrie Wagner's direct line