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Central Services Human Resource ;,~ ~ ~ ,; ' And Risk Services MEMORANDUM Date: May 24, 2004 To: City of Eugene Non-Represented Employees From: HRRS Benefits Program Staff Subject: FY2005 Health Plan Open Enrollment: City of Eugene 777 Pearl Street, Room 101 Eugene, Oregon 97401 (541)682-5061 (541) 682-6831 FAX www.ci.eugene.or.us Tune 7 - 18, 2004 Open Enrollment This year the health plan open enrollment period will be held June 7 - 18, 2004. The open enrollment period is normally the only time during the year when you may change from one health plan to another or add any eligible dependents. If you want to change health plans or add dependents, you must complete the appropriate enrollment forms and submit to Human Resource & Risk Services (HRRS), City Hall Room 101, by 5 PM, Friday, June 18, 2004. All changes will be effective July 1, 2004, and will obligate you through June 30, 2005. Health Plan Options The health plan options are: • The City Health Plan (self-insured plan administered by ODS Health Plans), or •PacificSource Health Plans (a managed care option) If you join the City Health Plan, you must complete the City's enrollment form. If you join PacificSource, you must complete their enrollment form in addition to the City's form. Enrollment materials (including provider directories) will be available from HRRS. Enrollment forms are also available on the HRRS Benefits Program Website. Payroll Deductions Full-time Non-represented employees wanting health coverage are required to pay 8% of the health insurance premium cost, regardless of family size. The payroll deductions (taken on the first two paychecks each month) are on a pre-tax basis, except for coverage of domestic partners. The FY2005 payroll deductions for full-time employees are: Citv Health Plan PacificSource Individual: $15.90/Pay Period $11.23/Pay Period Two-Party: $29.38/ Pay Period $22.60/ Pay Period Family: $41.05/Pay Period $33.01/Pay Period (Continued on Reverse)