Government » Jobs » Employment Information

New Employee Resources

heron standing on heron statue in mirror pondWelcome to the City of Salem! Here you will find benefits enrollment forms and information to assist you with electing your benefits options.

The City of Salem has five collective bargaining units that are represented under labor contracts. Your benefits are determined by your labor contract. If you are unsure of the contract for your position, please contact Human Resources for assistance.

Salem Housing Authority employee benefits are administered by CIS. Additional information is available online on the Salem Housing Employee Benefits page.

All employees are required to adhere to the human resources rules.

Required - New Hire Benefit Forms

Forms are due to Human Resources within 30 days hire date.

New Employee Benefits Forms Checklist

Form Description
1. Health Insurance Enrollment, Waiver, Change form Complete this form to enroll or waive coverage in the City of Salem health insurance plans.
2. Health Insurance Coordination of Benefits form Complete this form to report that you or your dependents have other health insurance coverage.
3. Flexible Spending Accounts (FSA) Enrollment or Waiver form 2024 Complete this form for enrollment or waiver in the flexible spending accounts for 2024
4. Standard Insurance Life, ADD, LTD Voluntary Enrollment Beneficiary Form Complete this form to designate or update your beneficiary on the City provided Life Insurance and AD&D policy.

 

The form is also used to enroll in the voluntary additional life insurance within 31 days of hire within the guaranteed issue limits of $100,000 employee, $20,000 spouse, and $10,000 child(ren).

 

This form is also used to enroll in the voluntary AD&D coverage of $25,000 - $300,000 for Employee only or Employee + Family.
5. Electronic Disclosure form Complete this form to acknowledge the City's intent to deliver plan documents and notices electronically.
6. Health Hub Service Agreement New Hire form Complete this form to agree to the terms of use for the Health Hub employee health clinic.
7. 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.
8. Health Savings Account (HSA) Enrollment form 2024 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 2024 enrollment


Optional - Voluntary Benefits Forms and Documents

Form or DOCUMENT Description
Voluntary Unum LTC Enrollment flyer  Enrollment in the voluntary long term care coverage is available within 31 days of hire within the guaranteed issue limits or can be elected at any time with application directly to Unum. Flyer includes rates and links to forms for available options.
Voluntary Additional Life Insurance Summary flyer Enrollment in the voluntary additional life insurance is available within 31 days of hire within the guaranteed issue limits of $100,000 employee, $20,000 spouse, and $10,000 child(ren) or can be elected at any time with application directly to Standard Insurance. Flyer includes rates for available options.
Voluntary ADD Insurance Summary flyer Enrollment in the voluntary AD&D coverage of $25,000 - $300,000 for Employee only or Employee + Family is available at any time.  Flyer includes rates for available options. 

Benefits Documents

Document Description
457 Voya Automatic Enrollment Notice New Employee AFSCME, Unrepresented, SCABU, PCEA and IAFF new hire employees are enrolled in a 1% auto-enroll process and will receive a packet from Voya with the option to opt-out or change amount prior to deadline
457 Voya Automatic Enrollment Notice New Employee SPEU SPEU new hire employees are enrolled in a 3% auto-enroll process but can choose to opt-out or change amount prior to deadline.
2024 Employee Benefits Guide Information regarding your benefits including costs of health insurance premiums
2024 Cigna HDHP SBC Summary of Benefits Coverage for the Cigna High Deductible Health Plan (HDHP) medical plan
2024 Cigna PPO OAP SBC Summary of Benefits Coverage for the Cigna PPO OAP medical plan
2024 Kaiser SBC Summary of Benefits Coverage for the Kaiser medical plan
2024 HRAVEBA Benefits Guide Summary of Benefits Coverage for HRAVEBA 

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.

Benefits by Employee Group