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 AFSCME Health Plan Options and Employee Rates175 KB2020-afscme-health-plan-options-and-rates.pdf
2020 COBRA, Retiree Health Insurance Premium Rates81 KB2020-cobra-retiree-health-insurance-premium-rates.pdf
2020 EBMS Plan Document Amendments577 KBebms-plan-document-amendments.pdf
2020 HDHP Summary of Benefits Coverage (SBC)543 KB2020-hdhp-sbc.PDF
2020 Kaiser Permanente Summary of Benefits (SBC)500 KB2020-kaiser-sbc.pdf
2020 PPO Summary of Benefits Coverage (SBC)573 KB2020-ppo-sbc-all-other-groups.PDF
2021 AFSCME Health Plan Options and Employee Rates207 KBafscme-health-plan-options-and-rates.pdf
2021 COBRA, Retiree Health Insurance Premium Rates82 KBcobra-retiree-health-insurance-premium-rates.pdf
2021 HDHP Summary of Benefits (SBC)290 KBhdhp-sbc.pdf
2021 Health Insurance Premiums with Total Premium Rates195 KBhealth-insurance-premiums-all-employee-groups.pdf
2021 Kaiser Permanente Summary of Benefits (SBC)492 KBkaiser-sbc.pdf
2021 PPO Summary of Benefits Coverage (SBC)297 KBppo-sbc.pdf
Domestic Partner Policy108 KBdomestic-partner-policy.pdf
HDHP and HSA FAQ Flyer279 KBhow-the-hdhp-and-hsa-work-flyer.pdf
HDHP Plan Document1512 KBhdhp-plan-document.pdf
Health Hub Health Clinic Flyer3346 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 Contribution Summary90 KBhra-veba-contribution-summary.pdf
HRAVEBA Plan Brochure3263 KBhra-veba-plan-brochure.pdf
HRAVEBA Plan Document367 KBhraveba-plan-document.pdf
HRAVEBA Plan Summary 307 KBhra-veba-plan-summary.pdf
HRAVEBA Summary of Benefits (SBC)562 KBhraveba-sbc.pdf
Kaiser 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 Summary58 KBkaiser-summary.pdf
Kaiser Permanente Quick Access and Telehealth flyer144 KBkaiser-quick-access-telehealth-flyer.pdf
Kaiser Permanente Welcome flyer77 KBkaiser-welcome-flyer.pdf
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2021 Moda Delta Dental plan changes117 KB2021-moda-dental-plan-changes.pdf2021-moda-dental-plan-changes.pdf Checked Out To: Carrie Wagner
Moda Delta Dental Incentive Dental Plan Document2321 KBdental-plan-document-incentive.pdf
Moda Delta Dental Incentive Plan Summary 2125 KBdental-moda-incentive-plan-summary.pdf
Moda Delta Dental Traditional (Constant) Dental Plan Document2259 KBdental-plan-document-traditional.pdf
Moda Delta Dental Traditional (Constant) Plan Summary1499 KBdental-moda-traditional-plan-summary.pdf
Willamette Dental Plan Document346 KBdental-plan-document-willamette.pdf
Willamette Dental Summary of Benefits102 KB2020-dental-summary-willamette.pdf
Vision Plans303 KBvision-plans-500.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
Cascade EAP GlobalFit Gym Discount flyer1102 KBeap-globalfit-gym-discounts-flyer.pdf
Cascade EAP Summary of Services Flyer155 KBeap-summary-of-services.pdf
Cascade EAP Work Family Life Flyer434 KBeap-work-family-life-flyer.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
Wills143 KBeap-flyer-wills.pdf
EBMS Flexible Spending Accounts Frequently Asked Questions Flyer83 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 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
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 Instructions2190 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 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
457 Voya and Roth Savings Compare215 KB457-roth-savings-compare.pdf
2021 COBRA, Retiree Health Insurance Premium Rates82 KBcobra-retiree-health-insurance-premium-rates.pdf
2020 COBRA, Retiree Health Insurance Premium Rates81 KB2020-cobra-retiree-health-insurance-premium-rates.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 Policy107 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 Flyer96 KBtravel-assistance.pdf
2020 Flexible Spending Accounts (FSA) Enrollment or Waiver form144 KB2020-flexible-spending-accounts-enrollment-or-waiver-form.pdf
2020 Health Insurance Enrollment, Waiver, Change form162 KB2020-health-insurance-enrollment-form.pdf
2020 Health Insurance Opt-Out Waiver Incentive form137 KB2020-health-insurance-opt-out-waiver-incentive-form.pdf
2020 Health Savings Account (HSA) Enrollment form144 KB2020-health-savings-account-enrollment-form.pdf
2021 Flexible Spending Accounts (FSA) Enrollment or Waiver form176 KBflexible-spending-accounts-enrollment-or-waiver-form.pdf
2021 Health Insurance Enrollment, Waiver, Change form165 KBhealth-insurance-enrollment-form.pdf
2021 Health Insurance Opt-Out Waiver Incentive form158 KBhealth-insurance-opt-out-waiver-incentive-form.pdf
2021 Health Savings Account (HSA) Enrollment form150 KBhealth-savings-account-enrollment-form.pdf
ADA Employee Request for Accomodation 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 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 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 or Dependent Name Change form158 KBhr-063-employee-or-dependent-name-change-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 form55 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
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
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
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 form590 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
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.
406 KB
HIPPA Notice of Privacy Practices
Notice of the City of Salem's privacy practices related to protected health information.
172 KB
Marketplace Coverage Options Notice
Required notice of Marketplace coverage options.
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