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Open Enrollment Benefits for City of Salem Employees

All forms must be received by Human Resources before 2024 Open Enrollment ends November 9, 2023, at 5:00 p.m.

In-person and Virtual Benefits Fair

This year we are excited to offer an in-person Benefits Fair on November 2, 2023, 10am-2pm in the Salem Public Library’s Anderson Rooms. We will also offer virtual Benefits Fair events for the week of October 30, 2023 – November 3, 2023 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.

What’s Changing for 2024 

  • The Health Care account FSA annual maximum will remain at $3,050. The maximum rollover amount will remain at $610 until the IRS limits are revised. Flexible Spending Accounts (FSA) are calendar year accounts. If you wish to elect a 2024 account, please complete the Flexible Spending Enrollment form. The form must be completed each year.
  • The Moda Traditional dental plan annual maximum will increase to $1,800.
  • The Cigna vision network is changing from VSP to Eyemed
  • The Cigna High Deductible Health Plan (HDHP) medical plan deductible is increasing per IRS regulations to $1,600 employee only and $3,200 employee + dependent(s).
  • The health insurance premiums have changed, 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 employees.
  • The Health Savings Account (HSA) 2024 IRS annual contribution limit is increasing to $4,150 for employee only, and $8,300 for employee plus dependent(s). If you are age 55+, you may contribute an additional $1,000.
  • The City contribution to the Health Savings Account (HSA) is changing to $133.34 per month for employee only HDHP enrollment, and $266.67 per month for employee plus dependent(s) HDHP enrollment. Pro-rated per FTE for part-time employees. IAFF and SPEU employees enrolled in the will have the City contribution sent to the HRAVEBA due to IRS regulations.
  • Unrepresented and SCABU employee’s Long-Term Disability (LTD) coverage benefit waiting period will change from 120 days to 90 days.
  • IAFF employees will have a new benefit to replace the HRAVEBA Employer contribution. The MERP contribution is based on hire date following completion of probation.
  • IAFF employees’ City provided life insurance and ADD coverage is changing from a flat rate of $40,000 to your annual salary as of January 1, 2024. The coverage amount will update annually every January 1.

Domestic Partner Policy

The Domestic Partner policy has been updated to allow health insurance coverage for Domestic Partners of any sex that meet the eligibility requirements.

  • 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 2024
  • Domestic Partner Affidavit form 2024
  • Domestic Partner Certification for Dependent Tax Status form 2024

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 2024 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 2024 Flexible Spending Account, you must re-enroll and complete a new FSA Enrollment form each year.

All forms must be received by Human Resources before 5:00 p.m. on November 9, 2023. Forms can be sent by interoffice mail or emailed to the Benefits Team at benefits@cityofsalem.net.

The effective date of all benefit changes is January 1, 2024

Benefits Guide and Health Insurance Premium Rates

Cigna Additional Resources

Summary of Benefits Coverage (SBC)

Open Enrollment Forms

Form Description
2024 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 2024.
2024 Health Insurance Coordination of Benefits Form Complete this form to report that you or your dependents have other health insurance coverage for 2024.
2024 Open Enrollment Flexible Spending Account (FSA) Enrollment Form  Complete this form to participate in the flexible spending accounts (FSA) for 2024. A new form must be completed each year.
2024 Open Enrollment Limited Purpose Flexible Spending Account (FSA) Enrollment Form Complete this form if you elect HDHP medical plan with HSA for 2024 and expect to have 2023 Health Care FSA dollars roll over to 2024. The account funds must be moved to a limited purpose account to have an HDHP/HSA per IRS regulations.
2024 Open Enrollment Health Insurance Opt-Out Waiver Incentive Form  Complete this form to waive coverage on the City's health plan for 2024 because you have other qualifying health insurance. Documentation of enrollment in other qualifying coverage is required.
2024 Health Savings Account (HSA) Enrollment Form Complete this form if you elect to enroll in the HDHP medical plan for 2024 or qualify for the 2024 Opt-Out Waiver Incentive and are HSA eligible per IRS rules. The other insurance must be a HDHP medical plan.

Beneficiary Update Forms

Form Description
PERS IAP Beneficiary form Complete this form if you wish to update your beneficiary on your PERS IAP retirement account.
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.
Standard Insurance Life, ADD, LTD, Voluntary Additional Life, and Voluntary AD&D Insurance Beneficiary Form Standard Insurance has consolidated the forms. Complete this form if you wish to update your beneficiary on your life insurance and AD&D plans.

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.