Changes to your health insurance coverage can only be completed due to a qualifying life event or during the annual open enrollment period.

The deadline to submit the Health Insurance Enrollment/Change form and required documentation must be within 30-days or 60-days from the event date depending on the situation. Failure to submit the form by the deadline may result in your change not taking effect until open enrollment for the next plan year with the effective date of January.

The Health Insurance Enrollment/Change form and Beneficiary Change forms are available online on the Human Resources and Employee Benefit Forms page or by request. Forms can be submitted to the Benefits Team by email Benefits@cityofsalem.net or interoffice mail to HR-Benefits.

Many life events may require you to update your tax withholding. Payroll W-4 tax forms are available online on the Human Resources and Employee Benefit Forms page or by request. Forms can be submitted to the Payroll Team by email COSPayroll@cityofsalem.net or interoffice mail to Payroll.

Marriage

• You may add your new spouse, and stepchild(ren), if applicable, to your health insurance within 60 days after your date of marriage by completing a Health Insurance Enrollment/Change form AND provide a photocopy of the marriage license. Enrollment of a stepchild will also require a photocopy of the child’s birth certificate.
• The coverage will be effective the first of the following month of the marriage date.

Birth, Adoption, and Legal Guardianship

• You have 60 days after the baby is born, the adoption has taken place, or legal guardianship has been established by court decree to add a child to your health insurance by submitting a Health Insurance Enrollment/Change form AND provide a photocopy of the birth certificate or court paperwork.
• The coverage will be effective the date of the birth, adoption, or legal guardianship. 

Divorce

A former spouse is no longer eligible for coverage under the City of Salem Benefits plans, even with a court order, except when self-paying premiums under COBRA continuation coverage.

• Within 60 days of the divorce becoming final, you must submit a Health Insurance Enrollment/Change form AND a photocopy of the divorce decree to remove your former spouse, and stepchildren if applicable.
• The coverage will be terminated effective the end of the month of the divorce final date.
• COBRA continuation coverage will only be offered to the former spouse if the form to remove the spouse is received within 60 days of the divorce date.

Ineligible Child – Age 26

• Eligible children can remain on the health insurance plans until age 26.  Coverage for the child will be automatically terminated the end of the month that the child attains age 26 and no form is required. COBRA continuation coverage will be automatically offered to the child.
• The child can only remain covered on the health insurance plans after age 26 if they have been approved due to disability. The Disabled Dependent Certification form will need completed and approved by the City of Salem Benefits Team prior to the termination date. The form is available online or by request.   

Death of Dependent

• In the unfortunate event of the passing of a spouse or child, please submit a Health Insurance Enrollment/Change form within 60 days of the death to remove the spouse or child from your health insurance plans. 

Loss of Other Coverage – Add Dependent

• If your eligible dependent(s) lose coverage during the benefit plan year, you may be eligible to add them to your health insurance plans. You have 60 days from the loss of coverage to add a dependent.  You will need to submit a Health Insurance Enrollment/Change form AND proof of loss of coverage, such as a letter from the other insurance company or employer. You may also be required to submit a photocopy of the marriage license or a child’s birth certificate as proof of the relationship.

• The coverage will be effective the first of the following month of the other insurance termination date.

Loss of Other Coverage – New Enrollment

• If you previously waived our health insurance plans and you lose other insurance coverage during the benefit plan year, you may be eligible to enroll in the health insurance plans. You have 30 days from the loss of coverage to enroll. You will need to submit a Health Insurance Enrollment/Change form AND proof of loss of coverage, such as a letter from the other insurance company or employer. Dependents will also require documentation of proof of the relationship such as a photocopy of the marriage license or a child’s birth certificate.
• The coverage will be effective the first of the following month of the other insurance termination date.

Job Status Change – New Enrollment

• If you previously waived our health insurance plans and you experience a job status change such as changing to full-time from part-time during the benefit plan year, you may be eligible to enroll in the health insurance plans. You have 30 days from the event to enroll.  You will need to submit a Health Insurance Enrollment/Change form. Dependents will also require documentation of proof of the relationship such as a photocopy of the marriage license or a child’s birth certificate.
• The coverage will be effective the first of the following month of the job status date.

Job Status Change – Cancel Coverage

• If you experience a job status change such as changing to part-time from full-time during the benefit plan year, you may be eligible to cancel your enrollment in the health insurance plans due to cost change of pro-rated premiums. You have 30 days from the event to cancel your coverage.  You will need to submit a Health Insurance Enrollment/Change form.
• The coverage will be terminated effective the end of the month of the job status date.

Beneficiary Form Changes

Life event changes are a good time to evaluate your beneficiary forms, but beneficiary changes can be completed at any time. Forms are available online or by request.

• PERS beneficiary updates can be completed at any time by completing a PERS beneficiary form.
• Life insurance beneficiary updates can be completed at any time by completing a Standard Insurance Enrollment/Beneficiary form.
• If you participate in the Voya 457(b) Deferred Compensation Plans, you may want to update your beneficiary. Changes are completed online in the Voya system once logged into your account. Please contact VOYA at 800-584-6001 if you need assistance.

If you participate in the HRAVEBA plan, you may want to update your beneficiary. Changes are completed online in the HRAVEBA system once logged into your account. Please contact HRAVEBA at 888-659-8828 if you need assistance.