AFSCME (General Service) Employee Benefits

​The City of Salem offers their career AFSCME employees a generous benefits package.

 

HDHP - Plan Document1474 KBhdhp-plan-document.pdf
HDHP - Summary of Benefits Coverage606 KBhdhp-sbc.pdf
Health Insurance Enrollment Form123 KBhealth-insurance-enrollment-form.pdf
Health Plan Premium Rate Sheet107 KBhealth-plan-premium-rate-sheet.pdf
Kaiser - Plan Document901 KBkaiser-medical-plan-document.pdf
PPO Plan Document - AFSCME1510 KBppo-plan-document-afscme.pdf
PPO Summary of Benefits Coverage - All Other Groups613 KBppo-sbc-all-other-groups.pdf
Summary of Benefits Coverage - Glossary90 KBsbc-glossary.pdf
Willamette Dental Plan Document
618 KB
Delta Dental Plan - Summary of Benefits
207 KB
Willamette Dental - Summary of Benefits
149 KB
Willamette Dental Enrollment Guide
3070 KB
Incentive Dental Plan Document
1725 KB
Traditional Dental Plan Document
1722 KB
Vision Plan - $500243 KBvision-plans-$500.pdf

Cascade Centers - EAP (800) 433-2320

Eldercare252 KBeap-flyer-eldercare.pdf
Financial Coaching468 KBeap-flyer-financial-coaching.pdf
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
FSA - Claim Form55 KBfsa-claim-form.pdf
FSA - FAQ's424 KBfsa-faqs.pdf
FSA - Mid Year Change Form118 KBfsa-mid-year-change-form.pdf
FSA - Orthodontia Contract Form34 KBfsa-orthodontia-contract-form.pdf
FSA - Plan Document436 KBfsa-plan-document.pdf
Life - ADD AFSCME Policy121 KBlifeadd-policy-afscme.pdf
LTD - AFSCME Policy120 KBltd-policy-afscme.pdf
Additional AD&D Policy70 KBadditional-add-policy.pdf
Additional AD&D Summary36 KBadditional-add-summary.pdf
Additional Life Policy186 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 Rates387 KBlong-term-care-plan-options-rates.pdf
PERS New Member Brouchure167 KBpers-new-member-brochure.pdf
457 Roth Option10131 KB457-roth-option.pdf
457 Retirement Choice II Booklet510 KB457-retirement-choice-ii-booklet.pdf
457 Online Account Access Instructions1862 KB457-online-account-access-instructions.pdf
457 Core Investment Options191 KB457-core-investment-options.pdf
457 Brokerage Window Option866 KB457-brokerage-window-option.pdf
457 Automatic Enrollment - AFSCME only15 KB457-automatic-enrollment-afscme-only.pdf
CERA Information173 KBcera-information.pdf
Employee Parking Permits17 KBemployee-parking-permits.pdf
Hearing - Health Discount Program759 KBhearing-health-discount-program.pdf
Travel Assistance96 KBtravel-assistance.pdf
2018 FSA Election Form147 KBfsa-election-form-open-enrollment-2018.pdf
2018 FSA Limited Purpose Election Form121 KBfsa-limited-purpose-election-form-open-enrollment-2018.pdf
2018 HSA Payroll Election Form142 KBhsa-payroll-election-form-2018.pdf
2018 Opt-Out Incentive Waiver Form130 KBopt-out-incentive-waiver-form-2018.pdf
Additional AD&D Policy70 KBadditional-add-policy.pdf
Additional AD&D Summary36 KBadditional-add-summary.pdf
Additional Life Policy186 KBadditional-life-policy.pdf
Additional Life Summary201 KBadditional-life-summary.pdf
City Paid Life and AD&D Insurance Beneficiary289 KBcity-paid-life-and-add-insurance-beneficary-form.pdf
Dental Claim Form653 KBdental-claim-form.pdf
EBMS - Medical, Dental, and Vision Form131 KBebms-medical-vision-claim-form.pdf
Electronic Disclosure Form33 KBelectronic-disclosure-form.pdf
FSA - Claim Form55 KBfsa-claim-form.pdf
FSA - Enrollment Authorization Form189 KBflexible-spending-enrollment-authorization-form.pdf
FSA - Mid Year Change Form118 KBfsa-mid-year-change-form.pdf
FSA - Orthodontia Contract Form34 KBfsa-orthodontia-contract-form.pdf
Health Enrollment Change of Information121 KBhealth-enrollment-change-of-information-form.pdf
Health Insurance Enrollment Form123 KBhealth-insurance-enrollment-form.pdf
HRA VEBA Election Form2542 KBhra-veba-election-form.pdf
HSA - Enrollment Form148 KBhsa-enrollment-form.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
Voluntary Additional AD&D Insurance Beneficiary Form215 KBvoluntary-additional-add-insurance-beneficiary-form.pdf
Voluntary Additional Life Insurance Beneficiary Form62 KBvoluntary-additional-life-insurance-beneficiary-form.pdf
Voya - EZ Enrollment Form486 KBvoya-ez-enrollment-form.pdf
Voya - Final Paycheck Deferral Form42 KBvoya-final-paycheck-deferral-form.pdf
Voya - Holiday Cash Out Deferral Form42 KBvoya-holiday-cash-out-deferral-form.pdf
Voya Beneficiary Maintenance Flyer402 KBvoya-online-beneficiary-maintenance-flyer.pdf

Notices

2016 Required Notice145 KBrequired-notices.pdf
2017 Health Plan Annual Required Notices248 KBannual-required-notices-2017.pdf
Cobra - General Notice39 KBgeneral-cobra-notice.pdf
HIPPA - Notice of Privacy Practices117 KBhippa-notice-of-privacy-practices.pdf
Marketplace Coverage Options54 KBmarketplace-coverage-options.pdf

Contact us

Michele BennettBenefits Manager (AIC)Carrie WagnerHuman Resources AssistantHuman Resources Department
Monday–Friday
8:00 a.m.–5:00 p.m.
555 Liberty ST SE RM 225
Salem OR 97301
Phone: