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Open Enrollment Benefits for City of Salem Employees

All Open Enrollment forms must be received by the Human Resources-Benefits division before the 2025 Benefits Open Enrollment ends November 8, 2024, at 5:00 pm.

Benefits Fair Events

This year we are excited to offer an in-person Benefits Fair on Halloween October 31, 2024, 10:00 am - 2:00 pm in the Salem Public Library Anderson Rooms. We will also offer virtual Benefits Fair events for the week of Monday October 28– Friday November 1 with a mix of registered live webinars, pre-recorded webinars, and handouts. The Benefits Fair events are a great opportunity to learn more about your benefits. Benefits Fair Flyer.    More information about the Benefits Fair events. 

What’s Changing for 2025 

  • The Health Care Flexible Spending Account (FSA) annual maximum will increase to $3,200. The maximum rollover amount will increase to $660. Flexible Spending Accounts (FSA) are calendar year accounts. If you wish to elect a 2025 account, please complete the Flexible Spending Account (FSA) Enrollment form. The form must be completed each year.
  • The Moda Traditional (Constant) dental plan orthodontia lifetime maximum will increase to $1,500. The grandfathered Incentive dental plan orthodontia lifetime maximum of $1,000 will not change. 
  • The Cigna High Deductible Health Plan (HDHP) medical plan deductible is increasing per IRS regulations to $1,650 employee only and $3,300 employee + dependent(s).
  • The health insurance premiums will increase, refer to the Benefits Guide below for additional details. Your portion of the premium will be deducted on your December paychecks. Premiums are pro-rated for part-time employee.
  • The Health Savings Account (HSA) 2025 IRS annual contribution limit is increasing to $4,300 for employee only, and $8,550 for employee plus dependent(s). If you are age 55+, you may contribute an additional $1,000.
  • The Employer contribution to the Health Savings Account (HSA) is increasing to $137.50 per month for employee only HDHP enrollment, and $275.00 per month for employee plus dependent(s) HDHP enrollment. Pro-rated for part-time employees. IAFF and SPEU employees enrolled in the HDHP medical plan will have the Employer contribution to the HRAVEBA account due to IRS regulations.
  • Per the SPEU union contract the employee health insurance premiums will increase from $110 month to $130 month. Pro-rated for part-time employees. 
  • Per the SPEU union contract the Employer-paid Basic Life and ADD will increase from $40,000 to coverage amount equal to your annual salary as of January 1st each year. The IRS requires an imputed tax on coverage amounts over $50,000 and you may see a payroll tax listed as GTL on your paycheck. 
  • Pending contract ratification and Counsel approval. Per the SPEU-S union contract Police Sergeant employees will move from Unrepresented-Police Management to SPEU-S, matching SPEU union contract benefits for health insurance premiums, Life/ADD, LTD, HRAVEBA, and PORAC. 
  • Pending contract ratification and Counsel approval. Per the AFSCME union contract the Long Term Disability (LTD) benefit will change from Employee paid to Employer paid. Employee paid premiums will discontinue in December. 

Domestic Partner Policy

The Domestic Partner policy has been updated for the 2025 imputed premium tax. Health insurance coverage is available for Domestic Partners that meet the eligibility requirements. The IRS requires an imputed tax on the health insurance coverage cost of the partner if they are not considered a tax dependent. 

  • Open Enrollment and qualifying life events are the only time you can add a Domestic Partner to your health plans.  
  • If you are Registered Domestic Partners, you must submit a copy of your Declaration of Oregon Registered Domestic Partnership. If you are non-registered Domestic Partners, you must complete the Domestic Partner Affidavit form attesting to eligibility.  
  • Under federal tax law, if your partner does not qualify as your tax dependent for health coverage purposes, then the value of the partner coverage will be included in your gross income as an imputed tax. The Domestic Partner Certification for Dependent Tax Status form must be completed annually to avoid taxation. We recommend you discuss with a tax professional to be sure your partner will qualify as a tax dependent.     
  • Domestic Partner Policy 2025
  • Domestic Partner Affidavit form
  • Domestic Partner Certification for Dependent Tax Status form

What You 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 2025 you must complete a new health insurance waiver form. If you are an 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 2025 Flexible Spending Account (FSA), you must re-enroll and complete a new FSA enrollment form each year. 

 All forms must be received by Human Resources-Benefits by 5:00 pm on November 8, 2024.

Open Enrollment forms can be submitted using one of the below methods:  

  1. Email forms benefits@cityofsalem.net
  2. Send forms to Human Resources-Benefits by inter-office mail
  3. New option to complete an electronic form in the NEOGOV system. If you have trouble logging into your NEOGOV account, please contact the Benefits team email for assistance. NEOGOV Open Enrollment Forms User Guide. 

The effective date of all benefit changes is January 1, 2025

Benefits Guide and Health Insurance Premium Rates

Cigna Additional Resources

  • A Cigna representative will be available during the Benefits Fair giving you the opportunity to ask questions and receive additional resources to help you understand your Cigna benefits and additional health resources available. 
  • If you are considering switching health plans to Cigna for the new year, a Cigna representative can assist with many questions you may have before you enroll. Contact a Cigna One Guide representative for assistance. 
  • Cigna offers many additional resources including digital ID cards, access to virtual care, and 24/7 health information line. Cigna Resource Guide. 
  • Cigna offers Medicare resource assistance to everyone regardless of medical plan enrollment. Visit the Cigna Medicare resource web page to help you understand your Medicare decisions. 
  • The Cigna Pharmacy National Preferred Formulary will be updated in January. Review the Cigna notice for changes. Members affected by the formulary change will be notified by Cigna. 
  • You can search for Cigna preferred providers online in your mycigna account. You also have the option to search providers online as Guest without logging into your account. The network is Open Access Plus: Cigna Health Care Provider Directory
  • Cigna Vision providers have a separate network of preferred providers with Eyemed: Vision Provider Directory            Eyemed customer service 888-353-2653

Summary of Benefits Coverage (SBC)

Open Enrollment Forms

Electronic forms are also available in the NEOGOV system. NEOGOV Open Enrollment Forms User Guide.

 Form Description
2025 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/or dental plans for 2025. Dependent documentation is required for all newly added dependents. 
Health Insurance Coordination of Benefits Form   Complete this form to report that you or your dependents have new other health insurance coverage for 2025. This form can be completed at any time if your family experiences changes to other insurance coverage. 
2025 Open Enrollment Flexible Spending Accounts (FSA) Enrollment Form  Complete this form to participate in the flexible spending accounts (FSA) for 2025. A new form must be completed each year.
2025 Open Enrollment Health Insurance Opt-Out Waiver Incentive Form  Complete this form to waive coverage on the City's health plan for 2025 because you have other qualifying health insurance. Documentation of enrollment in other qualifying coverage is required. The opt-out incentive is contributed to an HRAVEBA account unless the other insurance is a HDHP medical plan and eligible for an HSA Employer contribution per IRS rules.
2025 Open Enrollment Health Savings Account (HSA) Enrollment Form Complete this form if you elect to enroll in the HDHP medical plan for 2025 or qualify for the 2025 Opt-Out Waiver Incentive and are HSA eligible per IRS rules. The other insurance must be a HDHP medical plan.

 Beneficiary Update Forms - Changes can be completed at any time

Form Description
PERS IAP Beneficiary Form Complete this form if you wish to update your beneficiary on your PERS IAP retirement account. Notary is required. 
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. Notary is required. 
Standard Insurance Life, ADD, LTD, Voluntary Additional Life, and Voluntary AD&D Insurance Beneficiary Form Complete this form if you wish to update your beneficiary on your life insurance and AD&D plans for your benefits file. 
Voya Online Beneficiary Designation Flyer Voya 457 Deferred Compensation beneficiary changes are made online directly with Voya. Instructions included in the flyer. 

Required Notices

Notice Description
Cobra General Notice Health plan coverage continuation rights under COBRA.
Health Plan Annual Required Notices Health plans are required to provide certain notices to eligible health plan members.
HIPAA Notice of Privacy Practices Notice of the City of Salem's privacy practices related to protected health information.
Marketplace Coverage Options Notice Required notice of Marketplace coverage options.