Benefits & Leave
- Medical Insurance
- Supplemental Benefits & Retirement
- Leave
- Other
- 2008 Open Enrollment
Medical Insurance
Fire
Regence Blue Cross Blue Shield of Oregon
Benefit Summary (174K pdf)
Complimentary Care Benefit Summary (24K pdf)
Enrollment Change (350K pdf)
New Enrollment (50K pdf)
Pharmacy Benefit Summary (97K pdf)
Request a new ID Card
Vision Coverage Summary (51K pdf)
Web Site
Health Insurance Portability and Accountability Act (HIPAA)
Initial Notice (11K pdf)
Notice of Privacy Practices (41K pdf)
AFSCME, Police, Nonbargaining
PacificSource
Employee Address Change (21K pdf)
Enrollment Form (55K pdf)
Medical Benefit Summary-PPO Plan (11K pdf)
Medical Benefit Summary-Prime Plan (11K pdf)
Prescription Drug Claim (82K pdf)
Termination of Dependent Coverage (97K pdf)
Web Site
Walgreens Healthcare Plus Prescription Program
(PPO Participants Only)
Prescription Transfer (22K pdf)
Registration and Prescription Order (24K pdf)
ODS Health Plans
Enrollment-Change Form (358K pdf)
Vision Reimbursement Claim Form (108K pdf)
Web Site
Health Insurance Portability and Accountability Act (HIPAA)
Initial Notice (11K pdf)
Notice of Privacy Practices (41K pdf)
Retirement
Deferred Compensation (457 Plans)
ICMA Web Site
ICMA Cost Summary (22K pdf)
ICMA Deferral Change Form (28K pdf)
ICMA Employee Information Change Form (147K pdf)
Nationwide Cost Summary (13K pdf)
Nationwide Retirement Solutions
Oregon Public Service Retirement Program (PERS)
A-Z Quick Answers for OPSRP & IAP Members
A-Z Quick Answers for Tier 1&2 & IAP Members
Designation of Beneficiary Packet
Payee Change Request (294K pdf)
Web Site
Supplemental Benefits
Flexible Spending Account
(Manley)
Change Form (44K pdf)
Contact HR for Change Forms
Eligible Over-the-Counter Medicines (114K pdf)
Enrollment Form (104K pdf)
Manley Web Site
Request for Reimbursement (76K pdf)
Life Insurance/Long-Term Disability
(Standard Insurance Co.)
Enrollment and Change Form (485K pdf)
Life and or LTD Enrollment-Change Form (485K pdf)
Colonial Supplemental Short-Term Disability Insurance
Colonial Short Term Disability (1019K pdf)
AFLAC Insurance
Accidental Injury Claim-S-00198 (193K pdf)
Sickness Claim-S-2029 (206K pdf)
Web Site
CIGNA Term Life Insurance
Application (73K pdf)
Informational Brochure (130K pdf)
Leave
Family Medical Leave Act (FMLA)
Certification of Healthcare Provider (37K pdf)
Employee Info Packet (54K pdf)
Employee Leave Request (141K pdf)
Military Leave
Military Leave (499K pdf)
Overtime Request
Overtime Request (140K pdf)
Benefits
Summary of Benefits
AFSCME (26K pdf)
Executive Staff (27K pdf)
IAFF 56-Hour Employees (22K pdf)
Non-Bargaining (27K pdf)
Police-APA (27K pdf)
Affidavit of Domestic Partnership
Form (25K pdf)
Information Packet (30K pdf)
Memo (22K pdf)
Termination Form (19K pdf)
Employee Assistance Program
Information (175K pdf)
- Employee Assistance Program Brochure, Standard Insurance Co. (Intranet Only)
- Identity Theft Protection (Intranet Only)