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 2021. 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.

2022 Open Enrollment ends November 5, 2021, at 5:00 p.m.

Virtual Benefits Fair 

This year we are offering a virtual Benefits Fair for the week of October 25, 2021 – October 29, 2021 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.  Link to Benefits Fair web page 

What’s changing for 2022:

  • The 2021 Health Care FSA and the Dependent Care FSA accounts will have any remaining balance automatically rollover on April 1st adding to the 2022 account or creating a 2022 account at that time.
  • The 2022 Health Care account FSA annual maximum will remain $2,750.00 and the maximum rollover amount will remain $550. Flexible Spending Accounts (FSA) are calendar year accounts. If you wish to elect a 2022 account, please complete the Flexible Spending Enrollment form. The form must be completed each year.
  • The health insurance premiums have changed, 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 Health Savings Account (HSA) 2021 annual contribution limit is increasing to $3,650 for employee only, and $7,300 for employee plus dependent(s). If you are age 55+, you may contribute an additional $1,000.
  • AFSCME and Unrepresented employees only. The City contribution to the Health Savings Account (HSA) is increasing to $112.72 per month for employee only HDHP enrollment, and $326.88 per month for employee plus dependent(s) HDHP enrollment. Pro-rated per FTE for part-time employees.
  • SPEU Employees can enroll in the HDHP medical plan at $0 premium cost. The City contribution to the HRAVEBA is increasing to $76.88 per month for employee only HDHP enrollment, and $327.45 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 01/01/22 to $108.44 per month/$50.05 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 2022, you must complete a new health insurance waiver form. If you are an AFSCME, PCEA, SPEU, 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 2022 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 Human Resources before 5:00 p.m. on November 5, 2021. Forms can be sent by interoffice mail or emailed directly to Carrie Wagner at [email protected]. Forms can be submitted in person by appointment only by calling Carrie Wagner at 503-589-2085 or email [email protected].  

The effective date of all benefit changes is January 1, 2022

​Open enrollment packets

​Health plan options with 2022 employee premium rates

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

AFSCME Health Plan Options and Employee Rates 2022207 KB
IAFF Health Plan Options and Employee Rates 2022202 KB
PCEA Health Plan Options and Employee Rates 2022203 KB
SCABU Health Plan Options and Employee Rates 2022201 KB
SPEU CSO Part-time Health Plan Options and Employee Rates 2022205 KB
SPEU Health Plan Options and Employee Rates 2022204 KB
Unrepresented Health Plan Options and Employee Rates 2022207 KB

 

​Summary of benefits coverage (SBC)

HDHP Summary of Benefits Coverage (SBC) 2022hdhp-sbc.pdf372 KB
Kaiser Permanente Plan Summary 2022kaiser-summary-fair.pdf46 KB
Kaiser Permanente Summary of Benefits Coverage (SBC) 2022kaiser-sbc.pdf452 KB
Moda Delta Dental Incentive Plan Summary dental-moda-incentive-plan-summary.pdf1698 KB
Moda Delta Dental Traditional (Constant) Plan Summarydental-moda-traditional-plan-summary.pdf1318 KB
PPO IAFF Summary of Benefits Coverage (SBC) 2022ppo-iaff-sbc.pdf378 KB
PPO Summary of Benefits Coverage (SBC) 2022ppo-sbc.pdf378 KB

​Open enrollment forms

2022 Open Enrollment Flexible Spending Account (FSA) Enrollment form
Complete this form to participate in the flexible spending accounts (FSA) for 2022. A new form must be completed each year.
170 KB
2022 Open Enrollment Health Insurance Opt-Out Waiver Incentive form
Complete this form to waive coverage on the City's health plan  for 2022 because you have other qualifying health insurance. Documentation of enrollment in other qualifying coverage is required. AFSCME, PCEA, SPEU, and Unrepresented employees only.
154 KB
2022 Open Enrollment Health Savings Account (HSA) Enrollment form
Complete this form if you elect to enroll in the HDHP medical plan for 2022, or qualify for the 2022 Opt-Out Waiver Incentive and are HSA eligible per IRS rules, other insurance must be a HDHP medical plan.
147 KB
Commute Expense Reimbursement Account (CERA) Enrollment form
Complete this form if you wish to enroll in the voluntary Commute Expense Reimbursment (CERA) account for eligible van pool or mass transit costs. Enrollment can be completed at any time.
90 KB
Flexible Spending Accounts (FSA) Enrollment or Waiver form
Complete this form for enrollment or waiver in the flexible spending accounts for 2022
175 KB
Health Insurance Enrollment, Waiver, Change form
Complete this form to enroll or waive coverage in the City of Salem health insurance plans.
165 KB
Health Insurance Opt-Out Waiver Incentive form
Complete this form to waive coverage on the City's health plans because you have other qualifying health insurance.  Documentation of enrollment in other qualifying coverage is required. AFSCME, PCEA, SPEU, and Unrepresented employees only.
154 KB
Health Savings Account (HSA) Enrollment form
Complete this form if you elect to enroll in the HDHP medical plan, or qualify for the Opt-Out Waiver Incentive and are HSA eligible per IRS rules for 2022 enrollment
150 KB
Voya Deferred Compensation EZ Enrollment form
Complete this form to enroll and participate in the City of Salem Deferred Compensation Plan. Enrollment can be completed at any time.
590 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 Designation Flyer
Instructions to update your 457 Voya beneficiary online.
677 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.
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