Employee Benefits

General Summary, Information & Forms for City Participants


2021 Open Enrollment

October 1 – 30, 2020 for changes effective January 1, 2021.

It’s that time again – OPEN ENROLLMENT!  This is the one time each year when, without a qualifying event, you can:

  • add or delete dependents from Medical, Dental and Vision or choose a new Medical plan;
  • enroll in, increase or drop Voluntary Life Insurance;
  • enroll/re-enroll in a Section 125 Medical or Dependent Care Flexible Spending Account (FSA);
  • enroll in, or change, AFLAC coverages.

NOTE:  If you do not wish to change your benefits or re-enroll in an FSA, no action is required during Open Enrollment.

Medical, Dental, & Vison Changes*

2021 Active Employee Benefit Guide

NEW this year: self- service enrollments through our providers website!
Workterra Self-Service Guide

If you find technology intimidating, please use the downloadable Insurance Election Form.

Choosing the High Deductible Health Plan?  Be sure to establish a corresponding Health Savings Account (HSA) by completing a 2021 Sterling Enrollment Form.   

* when adding dependents to your benefits, proof of dependent status is required. Please review the Dependent Verification Instructions, for types of proof accepted.

Summaries of Benefits & Coverage
EPO SBC: Pending
80/20 SBC: Pending
90/10 SBC: Pending
HDHP SBC: Pending
Delta Dental SBC
VSP Vision SBC

Opt Outs

Opt-out is available for medical only – dental and vision coverage are non-voluntary, even if you are married to another City employee.
Medical Opt-Out Form & Certification of Other Coverage

Individuals who previously opted out will need to re-verify during Open Enrollment. HR will contact you individually to arrange renewed documentation.

Flexible Spending Account (FSA/Section 125)

FSAs must be re-elected annually

Flexible Spending Accounts are part of Section 125, established by the IRS. Section 125 allows employees to set aside money for future medical and child care costs on a pre-tax basis.

Employees can enroll in a Medical FSA or a Limited Purpose FSA (Dental & Vision Only), and/or a Dependent Care FSA.

2021 FSA Enrollment Form & Worksheet
FSA Medical Information
FSA Dependent Care Information


Book an appointment with our rep, Adam Brubaker!

Sign up for a meeting:

Current Available Times:
10/9: 7:30am-10:30am
10/12: 7:00am-1:00pm & 3:00pm-6:00pm
10/13: 1:30pm-5:30pm

Price Sheet
Election Form

City of Chico Dedicated Aflac Website:

Video Link For General Aflac Info:    

Questions? Contact Adam directly:
(530) 949-3767

ICMA-RC Deferred Compensation 

Contribute to an ICMA-RC retirement plan automatically each paycheck.
Did you know? CPSA and CPOA members have a 10% match!

While this information is listed under Open Enrollment, for ease of access, employees can elect Deferred Compensation at any time, and do not need to wait to start contributing until January. If you elect and would like to start January 1, please specify the start date to HR.

Enrolling online is quick and easy!

  1. Go to
  2. Enter and confirm your Social Security number, then enter your plan number: 307126
  3. Select your enrollment method:
    • Express: enter your personal information and contribution information. Later, through Account Access, you can submit your investment and beneficiary information.
    • Comprehensive: enter your personal information, beneficiary information, contribution information, investment allocations, and create a user ID.
    • Note: At this time, City employees can only elect dollar amounts and not percentages with ICMA. Please only list dollar amounts.
  4. Use the print enrollment form feature at the end of your online enrollment process to print the form.
  5. Provide HR a copy of your enrollment form and complete a copy of the ICMA Contribution Change Form in order to initiate your contribution through payroll deductions.

Need additional help? Watch a short video guide to see how easy it can be to enroll online. You can also contact the City’s ICMA-RC representative listed below.

Once you’re enrolled, use the following resources:

Voluntary Life Insurance

Don’t forget, this is in addition to the City Paid Group Life Insurance that is already provided to you at no cost!

All active, full-time, permanent employees working at least 20 hours per week and their eligible spouse and children are eligible for Voluntary Life Insurance.

Coverages Available:

  • Employee: $10,000 increments, up to 5x the employee’s annual earnings, not to exceed $500,000.
  • Employee Accidental Death & Dismemberment (AD&D): $10,000 increments, up to 5x the employee’s annual earnings, not to exceed $500,000. Coverage may be purchased regardless of whether or not voluntary life is purchased.
  • Spouse: $5,000 increments, up to 100% of employee coverage for voluntary life or AD&D.
  • Children, birth – 6 months: $1,000
  • Children, 6 months – 19 (or 26 if full-time student): $2,000 increments, not to exceed $10,000.

Open Enrollment Guaranteed Issue Amounts:
Employees already enrolled in Voluntary Life can elect/increase to up to the following amounts with no medical assessment required.

  • Employee: $20,000.
  • Employee AD&D: Up to 5x the employee’s annual earnings, not to exceed $500,000
  • Spouse: $10,000
  • Children, birth – 6 months: $1,000
  • Children, 6 months – 19 (or 26 if full-time student): $10,000

Enrollments or changes: download and complete a Lincoln Voluntary Life Application & Info form.


2021 Retiree & COBRA Benefit Guide

The City is contracted with Workterra for Retiree and COBRA insurance administration. Retirees or COBRA participants wishing to make an Open Enrollment change must contact Workterra directly at: 888-327-2770.

Retirees Turning 65

Retirees turning 65 within the next year do not need to make Open Enrollment election changes in anticipation of an eventual Medicare status. Turning 65 is a qualifying event and the change can be made within 30 days of your birthday.

Please notify Workterra within 30 days of your age 65 birthday and they will discuss the following options with you:

  • Dropping the City’s Retiree coverage. Note: your dependents cannot stay on the insurance if you are not on it; they will transition to COBRA coverage, with a limited term.
  • Retaining the City’s health insurance to use as secondary insurance (premiums will change).

Returning Forms to HR

    If you self-enroll on Workterra, you’re all done – they will notify us of your election changes.

    If you complete paper copies, please don’t email items containing social security numbers – it’s too risky.  Instead:

    • Put them in an interoffice envelope and send them to HR (just make sure they arrive no later than Friday, October 30th at 5PM)
    • Or try a new tool we’ve just installed on all City copiers! Scan your proxy card, press Scan > Scan to HR.  (Note a slight variation for PD copiers: Scan & Send > One-Touch > HR Scans – you may have to follow the down-pointing arrow/bottom right if there’s an extensive list.)  Your document will magically appear in a scan folder on our end and will be acknowledged by an HR staff person within a short period of time (watch your email for a confirmation).  Hold on to your originals until you receive confirmation; otherwise, no need to send the originals to HR.
    • Working from home and need another solution?  Reach out to Karen Allison, at 879-7908, to discover other options based on the technology you have available.

    Need Assistance?

    Staff Email Phone
    Natalie Janda 879-7906
    Karen Allison 879-7908
    Amanda Patton (Strand) 879-7905
    Jamie Cannon 879-7901
    HR Main Line 879-7900

    General Insurance

    City of Chico 2020 Benefits Guide - Active Employees
    City of Chico 2020 Benefits Guide - Retirees & COBRA

    Applications/Change Forms

    Benefits Application & Change Form - Active Employees
    Medical Opt-Out Form & Certification of Other Coverage

    ACA Regulations & Important Guidelines
    Preventive Services Covered under the Affordable Care Act
    Glossary of Health Coverage and Medical Terms
    American Heart Association Flyers
    Premium Assistance Under Medicaid and the Children's Health Insurance Program (CHIP)

    Anthem Blue Cross Medical Insurance

    Anthem Customer Service
    Customer Service: (800) 967-3015

    Plan Summary of Benefits &
    Coverage (SBC)
    EPO 2020 EPO SBC
    HDHP 2020 HDHP SBC
    PPO 80/20 2020 PPO 80/20 SBC
    PPO 90/10 2020 PPO 90/10 SB

    Anthem Blue Cross General Information
    How to Find a Provider Instructions
    Anthem Claim Form
    Take Care of Yourself - Preventative Services
    Anthem Special Services Flyers
    Anthem Live Health Online Flyer
    Anthem Temporary ID Card Instructions
    Anthem Blue Cross Online Resources
    Anthem Blue Cross Drug Formulary
    Anthem Specialty Pharmacy (HDHP)

    Express Scripts
    Customer Service: (800) 711-0917
    Medco Frequently Asked Questions
    Medco Mail Order Form
    Medco Claim Form

    Carrum Health
    Customer Service: (888) 855-7806
    Carrum Flyer
    Carrum What to Expect
    Carrum Frequently Asked Questions

    Sterling Health Savings Account (HSA)
    Customer Service: (800) 617-4729
    2021 Sterling Enrollment Form 
    Sterling HSA Salary Redirection Form (Payroll Change Form)
    Sterling Change Of Account Form

    Delta Dental Insurance
    Customer Service: (800) 765-6003
    Delta Dental SBC
    Find a Network Dentist

    Delta Dental Dentist Directory
    Delta Dental Informational Flyers
    Delta Claim Form
    Where's My Dental ID Card?

    VSP Vision Insurance
    Customer Service: (800) 877-7195
    Where's my VSP ID Card? Plus other FAQs.
    VSP Member Accounts Online
    VSP Schedule of Benefits
    VSP Primary Eyecare
    Exclusive VSP Rebates & Special Offers
    VSP Tru Hearing member Discount
    VSP Out Of Network Claim Form

    Employee Assistance Plan (MHN)
    Customer Service: (800) 322-9707
    MHN Informational Flyer
    MHN Legal Services Flyer
    MHN Financial Services Flyer
    MHN Evidence of Coverage

    Section 125 Flexible Benefits Program (Basic Pacific)
    Customer Service: (800) 574-5448
    Flexible Spending Account Calculator
    CBA Welcome Packet
    Section 125 Summary Plan Description
    Section 125 Reimbursement Form
    Section 125 Dependent Care Reimbursement
    Section 125 Direct Deposit Enrollment

    CalPERS Retirement
    Customer Service: 888-CalPERS (or 888-225-7377)
    CalPERS Beneficiary Designation
    Planning Your Service Retirement (Pub 1)
    Service Retirement Application (Pub 43)
    Retirement Allowance Estimate Request (BSD-470)
    Local Miscellaneous Benefits (Pub 8)
    Local Safety Benefits (Pub 9)
    Service Credit Purchase Options (Pub 12)
    Power of Attorney (Pub 30)
    Community Property Guide (Pub 38A)
    CalPERS Pension Worksheet

    ICMA Deferred Compensation
    Mark Tomasini, Retirement Plan Specialist
    (866) 749-5180
    ICMA Enrollment Form
    ICMA Contribution Change Form
    ICMA Fund Investment Listing
    ICMA Beneficiary Designation Form
    ICMA Direct Rollover Packet
    ICMA Pre-Retirement Catch Up Form
    ICMA Withdrawal Packet

    Lincoln Financial Group Life and Disability Insurance
    Summary of Life Insurance Benefits
    Lincoln Disability One
    Lincoln LifeKeys Flyer
    Lincoln Travel Connect Flyer
    Life Insurance Beneficiary Designation
    Short Term Disability Claim Form
    Lincoln City Paid Life and AD&D Policy Certificate
    Lincoln Voluntary Life Policy Certificate
    Lincoln Voluntary AD&D Policy Certificate

    Adam Brubaker
    (530) 949-3767

    Modifying Elections

    After medical, dental, vision, and flexible spending account elections are made, Internal Revenue Service (IRS) regulations generally permit changing those elections only during the next open enrollment (October of each year). However, if you experience a “qualifying event” during the year you may change certain benefit plan elections mid-year. The Human Resources & Risk Management Office must be notified of a qualifying event within 30 days of the event in order to make changes to your elections. No exceptions to the 30 day notification deadline are permitted. A qualifying event allows you to add or remove yourself or dependents from the City’s health plans, but does not allow you to change the plan you are enrolled in. Changes to the plan you are enrolled in may only be made during the City’s Open Enrollment Period, to be effective the first of the following year. At the time the change is requested you may be required to submit proof of the qualifying event or evidence of other coverage.

    Benefits Summaries

    Core Benefits Available

    CalPERS Retirement Medical (4 plan options)
    457 Deferred Compensation Dental + Orthodontic Benefit
    Short Term Disability Vision
    Long Term Disability Flexible Spending Account
    Employee Assistance
    Group & Voluntary Life Insurance

    Time Off Benefits

    Vacation Sick Leave
    Paid Holidays Military Leave
    Bereavement Leave Jury Duty Leave
    Personal Time Off/
    Management Leave*
    Maternity/Paternity Leave

    *Eligibility Depends on bargaining unit and position.

    Historical Summary of Employee Benefits - by Union

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