2025 Open Enrollment Guide.pdf

CLATSOP COUNTY

2025 OPEN ENROLLMENT GUIDE

Open Enrollment Guide

For Benefits Effective January 1, 2025

TABLE OF CONTENTS

Open Enrollment Checklist 2025 3

Open Enrollment Acknowledgement Form 5-6

What’s New for 2025? 7

Medical Coverage – Regence BC/BS 7

Moda Delta Dental 8

Medical, Vision & Dental Coverage by Group 8

Monthly Medical and Dental Cost in 202 5 8

Important Reminders 9

Health Savings Account 9

Flexible Spending Accounts 9

Employee Assistance Programs 10

Opting Out of Medical 10

Basic Life & Disabil ity Insurance 10

Voluntary Life Insurance 10

Resources 11

Disclaimer: The information in the attached benefits enrollment packet is presented for illustrative purposes and is based on information from benefit providers. While every effort was made to accurately report your benefits, discrepancies and errors are always possible. In case of discrepancy between the guide and actual plan documents, the actual plan documents will prevail. All information is confidential, pursuant to the Health Insurance Portability and Accountability Act (HIPAA) of 1996. If you have any questions about the guide, please contact Human Resources at extension 1300.

OPEN ENROLLMENT CHECKLIST 2025

September 30 through October 18, 2024

During the annual open enrollment period, you can make changes to your insurance coverage for the upcoming calendar year. Whether or not you anticipate changes, please follow these steps. Experts are available to work with you one-on-one should you have any questions.

Step 1 Medical Plan and Flexible Spending Accounts (FSA) on CIS-Connect

Login to the CIS-Connect (https://www.cisbenefits.org/ ) (Download CIS Open Enrollment ABCs.)

Go to Open Enrollment 2025 to confirm your medical plan. (For dental, see step 4.)

Review & update your personal information with any changes.

If you wish to participate in the dependent care flexible spending, confirm your contribution for 2025.

If you have or are choosing the PPO-H plan, confirm your healthcare flexible spending account participation (see page 4 in the attached open enrollment guide).

Are you choosing a different medical plan? Make the change in CIS and remember to complete and submit this enrollment form to HR.

Hit Save & Confirm!

IMPORTANT: Flexible spending accounts (both dependent care and healthcare) require re-enrollment annually. To participate in 2025, download the FSA Enrollment form and submit it to HR.

Step 2 Health Savings Account (HSA)

The high deductible health plan (HDHP) includes the additional benefit of a tax advantaged health savings account.

Do you wish to change your monthly contribution? You may do so at any time. Should you wish to change your deduction specifically as of January 1st, only the HSA Pretax Deduction form is required.

Are you changing to the HDHP with HSA in 2025? All three forms are required:

1. HSA Employee Profile & Authorization

2. HSA Pretax Deduction Form

3. HSA Supplemental Enrollment Form 2025

Step 3 Delta Dental (Moda)

To newly enroll in the dental plan or to drop, add, or remove dependents:

Download and complete the Delta Dental enrollment/change form and submit to HR. For more detailed information on the county’s dental plan, refer to the links on page 3 of this guide.

Step 4 The Standard Voluntary Life/AD&D Insurance

Review your life insurance statement. To purchase, increase, or lower your voluntary life insurance coverage:

Submit The Standard’s enrollment/change form to HR. For more detailed information on the county’s voluntary life insurance plan, refer to page 5 of this guide.

https://www.cisbenefits.org/ file:///C:/Users/ssteed/Downloads/201-OE-ABCs-2025%20(1).pdf file:///C:/Users/ssteed/Downloads/Medical-Enrollment-CIS-Regence%20(3).pdf file:///C:/Users/ssteed/Downloads/Flexible-Benefits-Enroll-Form-2024%20(3).pdf file:///C:/Users/ssteed/Downloads/HSA-Pretax-Deduction-Form%20(1).pdf file:///C:/Users/ssteed/Downloads/HSA-Employee-Profile-Authorization.pdf file:///C:/Users/ssteed/Downloads/HSA-Pretax-Deduction-Form%20(2).pdf file:///C:/Users/ssteed/Downloads/HSA-Pretax-Deduction-Form%20(2).pdf file:///C:/Users/ssteed/Downloads/HSA-Supplemental-Enrollment-2024.pdf file:///C:/Users/ssteed/Downloads/HSA-Supplemental-Enrollment-2024.pdf file:///C:/Users/ssteed/Downloads/Delta-Dental-Enrollment-Form%20(2).pdf file:///C:/Users/ssteed/Downloads/Standard-Life-Insurance-Enrollment-Change%20(3).pdf

2025 OPEN ENROLLMENT

ACKNOWLEDGEMENT FORM

Required for ALL Benefitted Employees

This form MUST BE RETURNED TO HR BY 10/18/2024 by inter-office mail, in-person, 503-338-3798 (fax) or hr@clatsopcounty.gov

Medical/ Vision I reviewed my medical plan in CIS and selected the following for 2025:

Medical/Vision I am opting out of the medical plan. Submit the Election to Opt-Out Medical Insurance form to HR.

I have made no changes to my medical plan.

I have made the following changes to medical plan (select one only):

You must select the new medical coverage in CIS AND submit the Medical Enrollment form to HR for coverage.

HDHP 4 Plan - CCLEA, FOPPO

Employee Only

Employee + Child

Employee + Children

Employee + Spouse

Employee + Family

HDHP 4 Plan - AFSCME, ONA, Unrepresented

Employee Only

Employee + Child

Employee + Children

Employee + Spouse

Employee + Family

PPO H Plan - CCLEA, FOPPO

Employee Only

Employee + Child

Employee + Children

Employee + Spouse

Employee + Family

PPO H Plan - AFSCME, ONA, Unrepresented

Employee Only

Employee + Child

Employee + Children

Employee + Spouse

Employee + Family

Yes. I have submitted the FSA enrollment form (both healthcare and dependent care) form to HR.

No. I am not enrolling in FSA in 2025.

FSA FSA’s requires re-enrollment annually. I selected my FSA amounts in CIS AND submitted the FSA enrollment form to HR.

file:///C:/Users/ssteed/Downloads/Waiver-and-Opt-Out-Medical-Dental-201909.pdf file:///C:/Users/ssteed/Downloads/Medical-Enrollment-CIS-Regence%20(4).pdf file:///C:/Users/ssteed/Downloads/Flexible-Benefits-Enroll-Form-2024%20(4).pdf

Dental No actions needed in CIS for dental. I selected the following for 2025:

I am opting out of the dental plan.

I have made no changes to my dental plan.

I have made the following changes to medical plan (select one only):

If you are making changes from your current coverage level, you must submit the Delta Dental Enrollment/Change form to HR.

Dental II - CCLEA, FOPPO

Employee Only

Employee + Child

Employee + Children

Employee + Spouse

Employee + Family

Dental III - AFSCME, ONA, Unrepresented

Employee Only

Employee + Child

Employee + Children

Employee + Spouse

Employee + Family

The Standard Optional - Voluntary Life Insurance

During open enrollment, you can purchase voluntary life insurance coverage in $10K increments up to five times your annual salary. A Medical History Statement (Evidence of Insurability or EOI) form is required when adding coverage in excess of $10K.

If you are making changes from your current coverage level, you must submit the Standard Life Insurance Enrollment Change form to HR.

Print - Employee First and Last Name

Employee Signature

Date file:///C:/Users/ssteed/Downloads/Delta-Dental-Enrollment-Form%20(3).pdf file:///C:/Users/ssteed/Downloads/Delta-Dental-Enrollment-Form%20(3).pdf file:///C:/Users/ssteed/Downloads/Standard-Life-Insurance-Enrollment-Change%20(1).pdf file:///C:/Users/ssteed/Downloads/Standard-Life-Insurance-Enrollment-Change%20(1).pdf

For assistance contact Human Resources at hr@clatsopcounty.gov or call ext. 1300.

Welcome to Open Enrollment Clatsop County strives to provide you and your family with a comprehensive and valuable benefits package. Open enrollment is a short window of time each fall when you can make changes to your benefits for the following calendar year. You can newly enroll or decline coverage, switch plans, or add/drop dependents. To make midyear changes (outside of the open enrollment), you must experience a qualifying life event, such as:

• Marriage, divorce, or legal separation

• Birth or adoption of a child

• Change in child’s dependent status

• Death of a spouse, child, or other qualified dependent

• Change in employment status or change in coverage under another employer-sponsored plan

• Gaining or Losing coverage in another health plan.

All active, regular full- or part-time Clatsop County employees working at least 20 hours per week are eligible to enroll in benefits. Your family members are also eligible for health coverage including your legal spouse, registered domestic partner, and legal child(ren) up to age 26.

NOTE: Many enrollments and changes require paper forms! Follow the instructions carefully. When in doubt, contact HR at extension 1300.

What’s New For 2025?

• Medical plan rates increased marginally: HDHP by average .05%, PPO-H plan by an average of .05%

Hinge Health is a free program for employees that helps to relieve back and joint pain with customized care plans.

• The health savings accounts’ (HSAs’) annual pre-tax contribution limits increase to $4,300 for an individual and $8,550 for family (individual plus dependent) coverage.

• Healthcare flexible spending accounts has a limit of $2,500 for an individual and $5,000 for family (individual plus dependent) coverage. In 2025 you may now roll $640 into the following year.

• SurgeryPlus: A new program offering access to the SurgeryPlus network of surgeons for common pre-planned surgeries.

Medical Coverage - Regence Blue Cross/Blue Shield City County Insurance services (CIS) is the county’s administrator for the medical plans offered by Regence.

VSP vision coverage is included with each medical plan. Two plan types are offered:

• High deductible health plans (HDHP) offer lower monthly premiums in exchange for higher deductibles and qualify for the additional benefit of a tax advantaged health savings account. You are responsible for the cost of services and prescriptions until your deductible is met. Once the deductible is met, you pay 20% of services until your annual out-of-pocket maximum is met. The HDHP offers an aggregate deductible, i.e. all paid expenses for yourself and dependents are totaled to reach the deductible and the out-of-pocket maximum. Please refer to your plan summary for deductible and out-of-pocket amounts.

• Preferred Provider Organizations (PPO) are the traditional option. Provider visits (and prescriptions) require a fixed copay amount unless a medical procedure is performed during the visit. Deductibles and out-of-pocket maximums are typically higher; however, the deductible is embedded, i.e. each person on the plan meets their own individual deductible and out-of-pocket maximum. The PPO qualifies for healthcare flexible spending accounts, which are also tax advantaged.

• Both plans include access to BeyondWell, a program that earns you up to $150 Amazon gift certificate.

mailto:hr@clatsopcounty.gov file:///C:/Users/ssteed/Downloads/Hinge-Health%20(2).pdf file:///C:/Users/ssteed/Downloads/501-ASI-Flex-Flexible-Spending.pdf file:///C:/Users/ssteed/Downloads/SurgeryPlus%20(1).pdf file:///C:/Users/ssteed/Downloads/004-OE_CIS-BeyondWell-program_Regence_2025.pdf

Moda Delta Dental Dental insurance is provided by Delta Dental and offers annual coverage of $2,000 per person. New subscribers are covered at 70% their first calendar year. Coverage increases by 10% each year thereafter as long as the insured has visited the dentist at least once during the calendar year.

Are you changing your dental coverage level? Complete and submit this enrollment form to HR.

Medical, Vision, Dental Coverage by Group Your plan eligibility is determined by your position’s employee group or bargaining unit (union affiliation). To download detailed plan summaries, click the linked headers in the table below or visit INSIDE:

Regence B lue Cross B lue Sh ie ld M ed ica l inc l . V is ion

M oda De l ta Denta l

EM PLOYEE GROUP HDHP-4 PPO-H VSP-A Dental II Dental III

Sheriff (CCLEA) & Parole & Probation (FOPPO) X X X X

All Other Groups (AFSCME, ONA, Unrepresented) X X X X

Your Monthly Medical & Dental Cost in 2025 The following tables show the employee share of monthly premiums per plan. CCLEA and FOPPO are presented in separate table due to the difference in the dental plan. For details on the full premiums and Clatsop County’s share, download the 2025 premium share detail.

CCLEA, FOPPO Medical & Dental II (bundled)

2024 % Incr/Decr Medical Only Dental II Only**

H D

H P

-4

Employee Only $75.47 $72.32 2.76% $69.99 $5.48

Employee+1 Child $141.29 $135.46 2.63% $130.27 $11.02

Employee+Children $189.04 $180.85 3.14% $178.02 $11.02

Employee+Spouse $159.75 $153.00 2.88% $148.90 $10.85

Employee+Family $222.14 $212.90 2.69% $205.34 $16.81

P

O

Employee Only $118.78 $113.50 3.47% $113.30 $5.48

Employee+1 Child $216.86 $207.34 3.33% $205.84 $11.02

Employee+Children $251.11 $240.12 3.45% $240.09 $11.02

Employee+Spouse $246.08 $235.11 3.52% $235.23 $10.85

Employee+Family $293.70 $281.25 3.07% $276.90 $16.81

AFSCME, ONA, Unrepresented

Medical & Dental II (bundled)

2024 % Incr/Decr Medical Only Dental II Only**

H D

H

-4

Employee Only $88.77 $86.32 4.18% $69.99 $6.81

Employee+1 Child $168.00 $163.58 4.13% $130.27 $13.69

Employee+Children $215.75 $208.97 4.33% $178.02 $13.69

Employee+Spouse $186.09 $180.73 4.23% $148.90 $13.49

Employee+Family $263.21 $256.13 4.16% $205.34 $20.92

P

O

Employee Only $132.08 $127.50 4.45% $113.30 $6.81

Employee+1 Child $243.57 $235.46 4.39% $205.84 $13.69

Employee+Children $277.82 $268.24 4.38% $240.09 $13.69

Employee+Spouse $272.42 $262.84 4.46% $235.23 $13.49

Employee+Family $334.77 $324.48 4.24% $276.90 $20.92 mailto:hr@clatsopcounty.gov file:///C:/Users/ssteed/Downloads/Delta-Dental-Enrollment-Form%20(4).pdf https://inside.clatsop.co.clatsop.or.us/download/2025-HDHP-4.pdf https://inside.clatsop.co.clatsop.or.us/download/2025-PPO-H.pdf file:///C:/Users/ssteed/Downloads/299-Vision-VSP-A.pdf file:///C:/Users/ssteed/Downloads/Dental-II.pdf file:///C:/Users/ssteed/Downloads/Dental-III.pdf file:///C:/Users/ssteed/Downloads/2025-Monthly-Premiums-Comprehensive-incl-COBRA%20(2).pdf

Important Reminders

• If you are considering a switch to the high deductible health plan (HDHP) with health savings account

(HSA), please review the HSA Supplemental Enrollment Form 2025 for eligibility rules.

• Only the HDHP-4 includes the additional benefit of an HSA.

• Both the HDHP-4 and the PPO-H include access to a dependent care flexible spending account (FSA).

• Only the PPO-H copay plan includes access to a healthcare flexible spending account.

• AFSCME members selecting the PPO also receive a Hra/VEBA funded annually by Clatsop County: $250 for individual coverage, $500 for individual+ dependent(s).

• All medical plans include access to MDLive (TeleHealth), which offers diagnosis and treatment by phone or live video at minimal cost ($42) toward the deductible.

Health Savings Account A Health Savings Account (HSA) is an additional county benefit that you can use to pay for qualified medical expenses, and it accompanies only a high deductible health plan. In 2025, the annual contribution limits are $4,300 for individual coverage and $8,550 for family coverage. If you are age 55 or older, you may make an additional catch-up contribution of $1,000. The county opens your health savings account with Optum Bank and contributes to the HSA on your behalf to help offset your deductible and other out-of-pocket qualified health expenses. A county-sponsored HRA/VEBA will be made available to employees who are ineligible to participate in the HSA.

In 2025, Clatsop County contributes:

• $1,100 if enrolled as single (employee only); or

• $2,200 if enrolled as employee plus one or more dependents.

• The county contribution amount is prorated for all mid-year hires and regular part-time employees working a minimum of 20 hours per week.

The benefits of a health savings account include:

• The account is portable, and the money in your HSA is carried over from year to year. It is yours to keep even if you leave the county.

• HSA contributions are made through pre-tax payroll deductions, which decreases your taxable income.

For complete information about HSA limitations and rules, visit https://www.irs.gov/pub/irs-drop/rp-24- 25.pdf.

Flexible Spending Accounts Clatsop County offers both a Health Care Flexible Spending Account (HCFSA) (available only with the PPO plan), and a Dependent Care Flexible Spending Account (DCFSA), which is available with both medical plans.

An FSA allows you to reimburse yourself for qualified healthcare and dependent care expenses with pre-tax contributions.

IMPORTANT: These are separate accounts. Each account requires an annual enrollment. Complete the FSA enrollment in CIS AND submitting the FSA Enrollment form with your updated elections to HR. care

• You may carry over only $640 of your healthcare FSA into the next calendar year.

• Dependent care funds must be spent in the calendar year in which you contributed funds.

mailto:hr@clatsopcounty.gov file:///C:/Users/ssteed/Downloads/HSA-Employee-Profile-Authorization%20(1).pdf file:///C:/Users/ssteed/Downloads/MDLIVE.pdf file:///C:/Users/ssteed/Downloads/Flexible-Benefits-Enroll-Form-2024%20(5).pdf

Employee Assistance Programs (EAP) There are two county-sponsored EAPs offered to all participating/covered employees and their household members whether or not the household members are actually covered under a policy. Both are confidential programs to assist with everyday work-life balance issues, such as mental health, substance abuse, gambling addictions, grief, financial planning, and more. Canopy offers five free visits per issue for employees with medical coverage, and The Standard’s program through Health Advocate offers an additional three free visits. Contact your provider to ask if he/she works with both programs. If yes, you will have eight visits with your provider per calendar year at no cost to you.

Opting Out/Waiving Medical Coverage If you already have medical coverage, you may waive the county’s coverage. A monthly cash payment of $100 is available to employees who provide proof of other coverage under a qualified group plan (typically a spouse’s employer plan). Proof of coverage must be provided annually. Insurance through state or federal marketplaces or government/military plans such as TRICARE, Medicare, Medicaid, or any individually purchased coverage does not qualify for purposes of the monthly cash payment (considered taxable income). Download the waiver form and submit it to Human Resources with your proof of other coverage.

Basic Life, AD&D, and LTD Insurance Clatsop County provides basic life insurance that includes accidental death and dismemberment and long-term disability at no cost to you. The basic coverage amount is based on your employee group/bargaining unit (union):

The Standard Life Insurance Class Definition Basic Coverage Amount

Class 1: Managers, unrepresented, nurses, district attorneys, and Courthouse Roads unit members

$40,000

Class 2: Represented sheriffs and parole and probation officers $30,000 (plus $10,000 statutory)

Voluntary Life/AD&D Insurance Additional coverage can be purchased, i.e. voluntary coverage, for which the monthly premium will be paid through payroll deduction. NOTE: During open enrollment, a medical history statement (evidence of insurability or EOI) is required when adding voluntary coverage for yourself in excess of $10,000. New employees may elect additional coverage of up to $100,000 during the initial enrollment period without EOI. The maximum coverage amount is five times your annual earnings.

We recommend that you review your designated beneficiaries during open enrollment. To make changes in your voluntary coverage amount (increase or reduce), submit the enrollment/change form to HR.

Follow this link to complete the medical history statement for evidence of insurability if required.

file:///C:/Users/ssteed/Downloads/Canopy-Employee-Assistance-Program-Serivces-Summary%20(1).pdf file:///C:/Users/ssteed/Downloads/The-Standard-EAP-2022-Health-Advocate%20(3).pdf file:///C:/Users/ssteed/Downloads/Waiver-and-Opt-Out-Medical-Dental-201909%20(1).pdf https://inside.clatsop.co.clatsop.or.us/download/Medical-History-Statement-Standard.pdf file:///C:/Users/ssteed/Downloads/Standard-Life-Insurance-Enrollment-Change%20(2).pdf https://inside.clatsop.co.clatsop.or.us/download/Medical-History-Statement-Standard.pdf

Resources Open enrollment files are available through the links provided in this document, on INSIDE (https://inside.clatsop.co.clatsop.or.us/annual-open-enrollment-2024/)

For general information, please contact Human Resources.

Plan providers are also available to answer questions:

Benefit Vendor/Group

Number Group/Policy

No.

Phone Website

Medical/Rx/Vision/FSA CIS Benefits

Administrator

855-763-3829 www.cisbenefits.org

Medical Regence of Oregon 96500033

888-370-6159 www.regence.com

Pharmacy Express Scripts CISRX4U 800-496-4182 www.express-scripts.com

Vision VSP 96500033 800-877-7195 www.vsp.com

Health Savings Account

(HSA)

Optum Bank 877‑470‑1771 https://www.optum.com/sign-in.html

Flexible Spending Account (FSA)

ASIFlex 800-763-3829 www.cisbenefits.org

Dental Delta Dental

(Moda) 10000137 888-217-2365 www.deltadentalor.com

Life & Disability Insurance

The Standard 146667 800-628-8600 www.standard.com

Employee Assistance Programs

Canopy EAP (CIS) 800-433-2320 Canopy Login

Health Advocate (The Standard)

888-293 6948 healthadvocate.com/standard3

Hinge Health CIS 855-902-2777 Email: hello@hingehealth.com

BeyondWell CIS/Regence www.regence.com

SurgeryPlus CIS Contact information will be available at a later date.

https://inside.clatsop.co.clatsop.or.us/annual-open-enrollment-2024/ https://inside.clatsop.co.clatsop.or.us/annual-open-enrollment-2024/ http://www.cisbenefits.org/ http://www.regence.com/ http://www.express-scripts.com/ http://www.vsp.com/ https://www.optum.com/sign-in.html https://www.optum.com/sign-in.html http://www.cisbenefits.org/ http://www.deltadentalor.com/ http://www.standard.com/ https://identity.personaladvantage.com/realms/canopy/login-actions/authenticate?client_id=https%3A%2F%2Fmy.canopywell.com%2Fsaml-sp.xml&tab_id=mTDVBOyAZ0o file:///C:/Users/ssteed/Downloads/The-Standard-EAP-2022-Health-Advocate%20(3).pdf mailto:hello@hingehealth.com https://www.regence.com/sign-in/?audience=individual file:///C:/Users/ssteed/Downloads/SurgeryPlus%20(2).pdf