2018 Open Enrollment - FORMS

Any changes submitted during Open Enrollment will take effect January 1, 2019.

Deadline to submit Open Enrollment forms (including FSA renewal) to the Human Resources Department is October 4, 2018, at 6:00 p.m.

 

EMPLOYEE BENEFITS FAIR

Take the time to understand your benefit choices so you can make sound decisions in choosing the right plan for you and your family. The City of Alameda will be hosting a benefit fair on September 20, 2018. Please stop by the Human Resources Department table, in addition to other benefit providers who will be available to answer your specific questions.

 

We know that benefits are an important piece of your puzzle of overall wellbeing. In order to help you find the right piece to complete your puzzle, CalPERS offers key resources on the CalPERS website (www.calpers.ca.gov) to help you choose the health plan that is right for you.  The Open Enrollment period is September 10 through October 4, 2018, at 6:00 p.m. (Deadline to submit Open Enrollment forms to the Human Resources Department is October 4, 2018, at 6:00 p.m. Although CalPERS’ Open Enrollment season officially ends on October 5th, City Hall is closed on Fridays.)

 

Open Enrollment is an opportunity to review your benefit elections and make changes to all your health plans for the 2019 calendar year. Actions that can be taken during Open Enrollment are:

  •  Change your CalPERS health plan
  •  Add or Remove dependents
  •  Enroll in CalPeRS health plan for 2019
  •  Waive Health coverage (if covered by a spouse or parent);
  •  Start or continue flex spending accounts

If you are not making any changes you do not need to submit any forms. Your benefits will remain the same and will continue without any interruption. The only exception is the Flexible Spending Account. If you elect to participate in the Flexible Spending Account (FSA) plan for the 2019 calendar year, a new enrollment form is required.

 

Any changes submitted during Open Enrollment will take effect January 1, 2019

 

Human Resources will also be hosting short 1-2 hour events at various locations throughout the City. The schedule is below, come talk with Human Resources to have your questions answered or get assistance with enrollment!

 

 

 

View the 2019 Benefits Summary

HERE

(City Contribution Amount)

 

 

Medical    

 

If you are seeking to add a new eligible dependent to your medical plan, please note that you will be required to provide certified documentation confirming their eligibility. Please be prepared to present either a marriage or birth certificate of your dependents with your enrollment form.

 

If you want to change your medical plan, please indicate the name of your new Health Plan in box #14 of the HBD12 Enrollment Form, and make sure you list all your eligible dependents (including yourself) in Section D box #15.


 

CalPERS Health Plan Rates

 

CalPERS Health Enrollment Form

 

 

Other Helpful Booklets & Forms

 

 

Vision

The Vision Service Plan (VSP) is a voluntary benefit, fully paid by the employee except safety personnel who split the premium 50/50 with the City. Please review the Summary of Benefits provided below to learn more about your coverage and copays.

 

www.vsp.com

 

 

Delta Dental

Dental enrollment is mandatory for all benefitted employees. This benefit is fully paid by the City of Alameda, and any eligible dependents can be enrolled or unenrolled during this season. Please review the Summary of Benefits provided below to learn more about your deductibles and services covered.

 

www.deltadental.com

 

 

 

Discovery Benefits Inc.

www.discoverybenefits.com

 

Transportation Savings Account (TSA)

 

Discovery Benefits Inc. will continue to provide a Transportation Savings Account (TSA), also commonly known as a Commuter Check Program. Employees interested in setting aside pre-tax funds for Parking or Mass Transit expenses, are encouraged to apply. There will be no Administrative Fee attached to this benefit, however, if an employee enrolls in the TSA benefit and either FSA program offered by DBI, the administrative fee for the FSA program will be reduced to $4.00/month. See the publications listed below to learn more about the benefits provided by the TSA program.

 

 

Flexible Spending Account (FSA)

 

Enrollment in the Discovery Benefits Inc. (DBI) FSA Health Care Reimbursement and the Dependent Care program requires an annual election. This means you must submit a new form even if you are setting aside the same amount as previous years. Through this program, employees are allowed to set aside pre-tax funds in the amount of $5,000 per calendar year ($2,500 if parents are filing taxes separately) for eligible dependent care expenses, or up to the legal limit of $2,650 per calendar year, for eligible health care expenses. DBI will provide all participants a free debit card that can be used for health care expenses, in lieu of requesting reimbursements. A monthly administrative fee will be deducted, in addition to the annual election amount, in the amount of $4.75/month. See the benefits guide provided below, to determine if this is a voluntary benefit you want to elect.

 

 

 

Life Insurance-VOYA

 

There is no formal open enrollment period to purchase voluntary supplemental life insurance for yourself and/or your eligible dependents. An Evidence of Insurability is required for all new elections; see form below. Please note that in order to purchase life insurance for your spouse and/or child(ren), you are required to purchase supplemental life insurance for yourself. Rate information is also provided below. This optional benefit is fully paid for by the employee.

 

This is also the opportunity to update your beneficiary information for your life insurance, including the City-paid Basic Life Insurance.

 

VOYA FORMS

 

Retirement Benefit and Forms

 

 

 

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