Open Enrollment Benefits for City of Salem Employees

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​The next open enrollment period for City of Salem employees will be in the fall of 2020. New hires, those who experience qualifying events, and other employees can find benefit forms and other helpful information in the jobs and employment section of this website.

2021 Open Enrollment ends November 6, 2020, at 5:00 p.m.

Virtual Benefits Fair 

This year we are offering a virtual Benefits Fair for the week of October 19, 2020 – October 23, 2020 with a mix of registered live webinars, pre-recorded webinars, and handouts. The Benefits Fair is a great opportunity to learn more about your benefits.  

What’s changing for 2021:

  • The prescription administrator for EBMS PPO and HDHP medical plans is changing from OptumRx to WellDyne effective January 1st, 2021. All employees enrolled in an EBMS medical plan will receive new health cards in December with the new prescription administrator information.

  • The Health Care account annual maximum has increased to $2,750.00 and the maximum rollover amount is increasing to $550. Flexible Spending Accounts (FSA) are calendar year accounts. If you wish to elect a 2021 account, please complete the Flexible Spending Enrollment form. The form must be completed each year.

  • The health insurance premiums have increased, refer to the health plan options document below for additional details. Your portion of the premium will be deducted on your December paychecks. Premiums are pro-rated for part-time employees.

  • AFSCME and Unrepresented employees only. The City contribution to the Health Savings Account (HSA) is increasing to $98.71 per month for employee only HDHP enrollment, and $286.26 per month for employee plus dependent(s) HDHP enrollment. Pro-rated per FTE for part-time employees.

  • The Health Savings Account (HSA) 2021 annual contribution limit is increasing to $3,600 for employee only, and $7,200 for employee plus dependent(s). If you are age 55+, you may contribute an additional $1,000.

  • Unrepresented employees have a new Hearing Aid benefit with Amplifon with a maximum of $3,000 every 2 years towards hearing aids.

  • SPEU employees with proof of other qualifying insurance will have the option to waive the City of Salem health plans and receive incentive funds to the HRAVEBA of $225 per month. Pro-rated per FTE for part-time employees. SPEU Employees will also have the option to enroll in the HDHP medical plan at $0 premium cost and a City contribution to their HRAVEBA of $62.14 per month for employee only HDHP enrollment, and $284.70 per month for employee plus dependent(s) HDHP enrollment. Pro-rated per FTE for part-time employees.

  • IAFF employees have an increase to their HRAVEBA effective 01/01/21 to $105.27 per month/$48.59 per paycheck, and effective 07/01/21 to $106.83 per month/$49.31 per paycheck.

What do I need to do?

Your current health insurance plan selections and covered dependents will remain the same unless you complete a form during open enrollment to elect a change.

However, the following items must be completed each year to maintain benefit coverage:

  • If you wish to waive the City of Salem health insurance for 2021, you must complete a new health insurance waiver form. If you are an AFSCME, PCEA, or Unrepresented employee that qualifies for the opt-out incentive, you must complete a new health insurance opt-out waiver incentive form and provide proof of other qualifying health insurance each year.

  • If you wish to enroll in a 2021 Flexible Spending Account, you must re-enroll and complete a new FSA Enrollment form each year.

  • If you are enrolled in the HDHP medical plan with the HSA, you must complete a new HSA Enrollment form each year.

All forms must be received by the Human Resources office before 5:00 p.m. on November 6, 2020. Forms can be sent by interoffice mail or emailed directly to Carrie Wagner at [email protected].  

The effective date of all benefit changes is January 1, 2021

​Open enrollment packets

2021 AFSCME Employee PacketAmerican Federation of State, County and Municipal Employees363 KB
2021 IAFF Employee PacketInternational Association of Fire Fighters357 KB
2021 PCEA Employee Packet911 Professional Communications Employees' Association361 KB
2021 SCABU Employee PacketSalem City Attorney's Collective Bargaining Unit361 KB
2021 SPEU CSO, Part-Time Employee PacketSalem Police Employees' Union358 KB
2021 SPEU Employee PacketSalem Police Employees' Union358 KB
2021 Unrepresented Employee PacketUnrepresented376 KB

​Health plan options with 2021 employee premium rates

View the Health Plan Options and Employee Premium rates to help you determine plan selection.

2021 AFSCME Health Plan Options and Employee Rates207 KB
2021 IAFF Health Plan Options and Employee Rates201 KB
2021 PCEA Health Plan Options and Employee Rates202 KB
2021 SCABU Health Plan Options and Employee Rates201 KB
2021 SPEU CSO Part-time Health Plan Options and Employee Rates205 KB
2021 SPEU Health Plan Options and Employee Rates203 KB
2021 Unrepresented Health Plan Options and Employee Rates207 KB

 

​Summary of benefits coverage (SBC)

2021 HDHP Summary of Benefits (SBC)hdhp-sbc.pdf290 KB
2021 Kaiser Permanente Summary of Benefits (SBC)kaiser-sbc.pdf492 KB
2021 PPO IAFF Summary of Benefits Coverage (SBC)ppo-iaff-sbc.pdf296 KB
2021 PPO Summary of Benefits Coverage (SBC)ppo-sbc.pdf297 KB
Kaiser Permanente Plan Summarykaiser-summary.pdf58 KB
Moda Delta Dental Incentive Plan Summary dental-moda-incentive-plan-summary.pdf2125 KB
Moda Delta Dental Traditional (Constant) Plan Summarydental-moda-traditional-plan-summary.pdf1499 KB
Willamette Dental Plan Summarydental-summary-willamette.pdf75 KB

​Open enrollment forms

2021 Open Enrollment Flexible Spending Account (FSA) Enrollment form
Complete this form to participate in the flexible spending account (FSA) for 2021. A new form must be completed each year.
171 KB
2021 Open Enrollment Flexible Spending Account (FSA) Limited Purpose Enrollment form
Complete this form if you elect the HDHP and expect to have 2020 Health Care FSA dollars roll over to 2021.
113 KB
2021 Open Enrollment Health Insurance Enrollment, Waiver, Change form
Complete this form to enroll or waive health insurance coverage, add or cancel dependent coverage, or change medical, vision, and dental plans for 2021.
164 KB
2021 Open Enrollment Health Insurance Opt-Out Waiver Incentive form
Complete this form to waive coverage on the City's health plan because you have other qualifying health insurance. Documentation of enrollment in other qualifying coverage is required. AFSCME, PCEA, SPEU, and Unrepresented employees only.
157 KB
2021 Open Enrollment Health Savings Account (HSA) Enrollment form
Complete this form if you elect to enroll in the HDHP medical plan for 2021 or qualify for the Opt-Out Incentive Waiver and are HSA eligible per IRS rules.
145 KB

​Beneficiary update forms

PERS IAP Beneficiary form
Complete this form if you wish to update your beneficiary on your PERS IAP retirement account.
802 KB
PERS Tier 1 or Tier 2 Beneficiary form
Complete this form if you are a PERS Tier 1 or Tier 2 member and wish to update your beneficiary on your PERS retirement account.
805 KB
Hartford Additional AD&D Insurance Enrollment Beneficiary form
Complete this form if you wish to enroll or update your beneficiary on your voluntary additional AD&D insurance policy. Enrollment can be completed at any time.
164 KB
Standard Additional Life Insurance Enrollment Beneficiary form
Complete this form if you wish to enroll in coverage during your 31 days qualifying event guarantee issue deadline, or wish to update your beneficiary on your voluntary additional life insurance policy.
69 KB
457 Voya Beneficiary Maintenance Flyer
Instructions to update your 457 Voya beneficiary online.
402 KB
Standard Life, ADD, and LTD Enrollment Beneficiary form
Complete this form to designate or update your beneficiary on the City provided Life Insurance and AD&D policy.
314 KB

​Required 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