2019 Open Enrollment


Open Enrollment for elections and changes effective January 1, 2019 is from November 14, 2018 to November 30, 2018.

All forms must be returned to City of Springfield Human Resources. 

The following benefits must be enrolled in annually and require employee action:

2019 Special Open Enrollment for Short Term Disability (STD) and Supplemental Life & Accidental Death and Dismemberment (AD/D)

Benefit Rates & Summary:


2019 IAFF


2019 SEIU

2019 SPA

Benefit Summary 


Medical & Dental:

You have the option to add/remove dependents from your plan or change dental plans effective for the 2019 plan year.  Dependent enrollment must be the same for Medical and Dental.  PacificSource will contact you directly about designating a primary care physician.

                 Remove Dependent(s) PacificSource Medical & MODA Dental Forms

                 Remove Dependent(s) PacificSource Medical and Willamette Dental Forms

                 Add Dependent(s) PacificSource Medical & MODA Dental Forms

                 Add Dependent(s) PacificSource Medical & Willamette Dental Forms

                 Change Dental Plans- MODA Dental to Willamette Dental Forms

                 Change Dental Plans- Willamette Dental to MODA Dental Forms

Waiver of Dependent Coverage Incentive:

If you waive coverage on eligible dependents who have other coverage and you are enrolled as a single participant on the City plan, with proof of dependent relationship and proof of other coverage, the city will fund your HRA account with the Two party/full family HRA amount.  You must re-enroll and submit proof annually at open enrollment to be eligible to receive the incentive.  

               Waiver of Dependent Coverage Form


Flexible Spending for Health Reimbursement, Dependent Care & Supplemental Health Premiums must be enrolled in annually. 

                 FSA Enrollment Form

Short Term Disability:

If you are not already enrolled in Short Term Disability, you may enroll for coverage with no medical underwriting. 

                 Short Term Disability Enrollment Form

Supplemental Life & ADD Insurance:

If you do not already carry Supplemental Life Insurance or Supplemental Accidental Death and Dismemberment insurance, you may enroll for the guaranteed issue amount with no medical underwriting.  Amounts over the guaranteed issue amount require additional approval. 

Guaranteed Issue amounts:

                 Supplemental Life Insurance / AD&D Enrollment Form

Sick Leave Reserve Program (SLRP):

SLRP is available to Non-Union, SEIU and AFSCME.  You must enroll annually.  Follow the instructions here to complete your SLRP enrollment for 2019.

                 SLRP Enrollment Instructions