Open Enrollment Benefits for City of Salem Employees

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2020 Open Enrollment ends November 1, 2019, at 5:00 p.m.

Benefits Fair 

Please join us on October 15, 2019 from 9:00 a.m. – 1:00 p.m. at the Salem Public Library in room Anderson A/B. The Benefits Fair is a great opportunity to learn more about your benefits. The Benefits team will also be available at the fair for benefits and open enrollment questions.  

Benefits Fair 

The Health Hub will be providing flu shots during the fair from 9:00 a.m. – 1:00 p.m. in the Library Plaza room.

Nationwide Pet Insurance  

The City of Salem has a new voluntary pet insurance benefit. A pet insurance policy can help you plan for your pet’s healthcare costs. Get a free, no-obligation quote today at 877-738-7874 or online at www.petinsurance.com/cityofsalem.

Nationwide Pet Insurance 

 What’s changing for 2020:

  • The Health Care account annual maximum has increased to $2,700.00. Flexible Spending Accounts (FSA) are calendar year accounts. If you wish to elect a 2020 deduction, 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.
  • The City contribution to the Health Savings Account (HSA) is increasing to $90.17 per month for employee only HDHP enrollment, and $261.50 per month for employee plus dependent(s) HDHP enrollment. Pro-rated per FTE for part-time employees
  • The 2020 annual contribution limit for the Health Savings Account (HSA) is increasing to $3,550 for employee only, and $7,100 for employee plus dependent(s). If you are age 55+, you may contribute an additional $1,000

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 2020, 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 2020 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 1, 2019.

The effective date of all benefit changes is January 1, 2020

​Open enrollment packets

2020 AFSCME Employee PacketAmerican Federation of State, County and Municipal Employees2020-afscme-employee-open-enrollment-packet.pdf333 KB
2020 IAFF Employee PacketInternational Association of Fire Fighters2020-iaff-employee-open-enrollment-packet.pdf330 KB
2020 PCEA Employee Packet911 Professional Communications Employees' Association2020-pcea-employee-open-enrollment-packet.pdf332 KB
2020 SCABU Employee PacketSalem City Attorney's Collective Bargaining Unit2020-scabu-employee-open-enrollment-packet.pdf330 KB
2020 SPEU CSO Part-Time Employee PacketSalem Police Employees' Union2020-speu-cso-part-time-employee-open-enrollment-packet.pdf353 KB
2020 SPEU Employee PacketSalem Police Employees' Union2020-speu-employee-open-enrollment-packet.pdf329 KB
2020 Unrepresented Employee PacketUnrepresented2020-unrepresented-employee-open-enrollment-packet.pdf335 KB

​Health plan options with 2020 employee premium rates

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

2020 AFSCME Health Plan Options and Employee Rates2020-afscme-health-plan-options-and-rates.pdf175 KB
2020 IAFF Health Plan Options and Employee Rates2020-iaff-health-plan-options-and-rates.pdf169 KB
2020 PCEA Health Plan Options and Employee Rates2020-pcea-health-plan-options-and-rates.pdf171 KB
2020 SCABU Health Plan Options and Employee Rates2020-scabu-health-plan-options-and-rates.pdf169 KB
2020 SPEU CSO Part-time Health Plan Options and Employee Rates2020-speu-cso-part-time-health-plan-options-and-rates.pdf169 KB
2020 SPEU Health Plan Options and Employee Rates2020-speu-health-plan-options-and-rates.pdf167 KB
2020 Unrepresented Health Plan Options and Employee Rates2020-unrepresented-health-plan-options-and-rates.pdf175 KB
Flyer - How the HDHP and HSA Workhow-the-hdhp-and-hsa-work-flyer.pdf279 KB

 

​Summary of benefits coverage (SBC)

2020 HDHP Summary of Benefits Coverage (SBC)2020-hdhp-sbc.PDF543 KB
2020 Kaiser Summary of Benefits (SBC)2020-kaiser-sbc.pdf500 KB
2020 PPO IAFF Summary of Benefits Coverage (SBC)2020-ppo-sbc-iaff.PDF571 KB
2020 PPO Summary of Benefits Coverage (SBC)2020-ppo-sbc-all-other-groups.PDF573 KB

​Open enrollment forms

2020 Open Enrollment Flexible Spending Account (FSA) Enrollment Form
Complete this form to participate in the flexible spending account (FSA) for 2020. A new form must be completed each year.
2020-open-enrollment-flexible-spending-account-enrollment-form.pdf137 KB
2020 Open Enrollment Flexible Spending Limited Purpose Enrollment Form
Complete this form if you elect the HDHP and will have 2019 FSA dollars roll over to 2020.
2020-open-enrollment-flexible-spending-limited-purpose-enrollment-form.pdf95 KB
2020 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 2020.
2020-open-enrollment-health-insurance-enrollment-change-form.pdf161 KB
2020 Open Enrollment Health Savings Account (HSA) Enrollment Form
Complete this form if you wish to elect to enroll in the HDHP medical plan for 2020 or qualify for the Opt-Out Incentive Waiver and are HSA eligible per IRS rules.
2020-open-enrollment-health-savings-account-enrollment-form.pdf143 KB

​Beneficiary update forms

City Paid Life and AD&D Insurance Beneficiary Form
Complete this form if you wish to update your beneficiary on your City-Paid Life Insurance and AD&D policy.
city-paid-life-and-add-insurance-beneficary-form.pdf289 KB
PERS IAP Beneficiary Form
Complete this form if you wish to update your beneficiary on your PERS retirement account.
pers-iap-beneficiary-form.pdf634 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.
pers-tier-1-or-tier-2-beneficiary-form.pdf1239 KB
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.
additional-add-insurance-enrollment-beneficiary-form.pdf164 KB
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.
additional-life-insurance-enrollment-beneficiary-form.pdf69 KB
457 Voya Beneficiary Maintenance Flyer
Instructions to update your 457 Voya beneficiary online.
457-online-beneficiary-maintenance-flyer.pdf402 KB

​Required notices

Cobra - General Notice
Health plan coverage continuation rights under COBRA.
132 KB
Health Plan Annual Required Notices
Health plans are required to provide certain notices to eligible health plan members.
226 KB
HIPPA - Notice of Privacy Practices
172 KB
Marketplace Coverage Options Notice
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