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_,_-;,.~,... Central Services <br />Human Resource <br />;,,~ r,: , And Risk Services <br />City of Eugene <br />777 Pearl Street, Room 101 <br />MEMORANDUM (541) 68 O 061n 97401 <br />(541) 682-6831 FAX <br />www.ci.eugene.or.us <br />Date: May 24, 2004 <br />To: City of Eugene AFSCME-Represented Limited Duration Employees and <br />AFSCME-Represented Benefitted Temporary Recreation Employees <br />From: HRRS Benefits Program Staff <br />Subject: FY2005 Health Plan Open Enrollment: )une 7 - 18, 2004 <br />Open Enrollment <br />This year the health plan open enrollment period will be held June 7 - 18, 2004. The open enrollment <br />period is normally the only time during the year when you may add any eligible dependents. <br />If you want to add dependents, you must complete the appropriate enrollment forms and submit to <br />Human Resource & Risk Services (HRRS), City Hall Room 101, by 5 PM, Friday, June 18, 2004. All <br />changes will be effective July 1, 2004, and will obligate you through June 30, 2005. <br />Enrollment materials (including provider directories) are available from HRRS. Enrollment forms are <br />also available on the HRRS Benefits Program Website. <br />Health Plan Options <br />The only health plan option for AFSCME-represented Limited Duration and Benefitted Temporary <br />Employees is the City Health Plan (self-insured plan administered by ODS Health Plans). <br />Payroll Deductions/Health Care Contributions <br />The City will pay the employee-only premium for AFSCME-Represented Limited Duration and <br />Benefitted Temporary Recreation Employees. If you want to add dependents, you may purchase <br />coverage through the City of Eugene at your own expense. The cost of coverage will be taken as a <br />payroll deduction on a pre-tax basis (except when covering domestic partner). For FY2005, the <br />amounts per pay period (first two pay periods in a month) are: <br />Coveraae Level Amount <br />Employee-only $0.00/pay period <br />Employee plus one dependent $179.21/pay period <br />Employee plus two or more dependents $334.16/pay period <br />Benefit Changes Effective )uly 1, 2004 <br />There are no benefit changes effective July 1st for the City Health Plan (administered by ODS Health <br />Plans) for AFSCME-represented Limited Duration and Benefitted Temporary Recreation Employees. <br />(Continued on Reverse) <br />