Open Enrollment 2020


Any changes submitted during Open Enrollment will take effect January 1, 2020
Forms must be submitted by October 3, 2019



If you are not making any changes you do not need to submit any forms. Your benefits will remain the same and will continue without any interruption. The only exception is the Flexible Spending Account. If you elect to participate in the Flexible Spending Account (FSA) plan for the 2020 calendar year, a new enrollment form is required.

Any changes submitted during Open Enrollment will take effect January 1, 2020.


Benefits Summary

The benefits summary matrix includes the City Contribution Amount towards health coverage.  Download here(PDF, 442KB).

2020-Benefits-Summary-Image.png(PDF, 442KB)

Health Plans

To select the right plan for you, check HERE to see which plans are available in your area.

CalPERS Health Benefit Summary
Health Program Guide

Since health care costs vary throughout California, regional pricing adjusts premiums to reflect the actual cost of health care in your specific region. This ensures that your CalPERS premiums are appropriate and competitive for where you live.

To find your specific health plan premium rates, choose your region from the options below:

 Region 1 Rates

View rates for Alameda, Alpine, Amador, Butte, Calaveras, Colusa, Contra Costa, Del Norte, El Dorado, Glenn, Humboldt, Lake, Lassen, Marin, Mariposa, Mendocino, Merced, Modoc, Mono, Monterey, Napa, Nevada, Placer, Plumas, Sacramento, San Benito, San Francisco, San Joaquin, San Mateo, Santa Clara, Santa Cruz, Shasta, Sierra, Siskiyou, Solano, Sonoma, Stanislaus, Sutter, Tehama, Trinity, Tuolumne, Yolo, and Yuba.

 Region 2 Rates

View rates for Fresno, Imperial, Inyo, Kern, Kings, Madera, Orange, San Diego, San Luis Obispo, Santa Barbara, Tulare, and Ventura.

Region 3 Rates

View rates for Los Angeles, Riverside, and San Bernardino.

Out-of-State Rates  

View rates for health plans available outside of California.

Health Enrollment Form (HBD12)(PDF, 391KB)
 Health Insurance Waiver Form(PDF, 98KB)

Change Medical Plan

If you want to change your medical plan, please indicate the name of your new Health Plan in box #14 of the HBD12 Enrollment Form, and make sure you list all your eligible dependents (including yourself) in Section D box #15.

Note: If you change your health plan but want to keep your physician or specialist, be sure to call the new health plan AND doctors to ensure they are part of the new health plan.

Add Dependents
If you are seeking to add a new eligible dependent to your medical plan, please note that you will be required to provide certified documentation confirming their eligibility. Please be prepared to present either a marriage or birth certificate of your dependents with your enrollment form.

 All information available at



The Vision Service Plan (VSP) is a voluntary benefit, fully paid by the employee except safety personnel who split the premium 50/50 with the City. Please review the Summary of Benefits provided below to learn more about your coverage and co-pays.

VSP Enrollment Form(PDF, 210KB)
VSP Benefits Summary(PDF, 816KB)


Dental enrollment is mandatory for all benefitted employees. This benefit is fully paid by the City of Alameda, and any eligible dependents can be enrolled or unenrolled during this season. Please review the Summary of Benefits provided below to learn more about your deductibles and services covered.

Delta Dental Enrollment Form(PDF, 155KB)
Delta Dental Benefits Summary (MISC)(PDF, 671KB)
Delta Dental Benefits Summary (SAFETY)(PDF, 696KB)

Flexible Spending Account

 Discovery Benefits, Inc.

Flexible Spending Account (FSA)

Enrollment in the Discovery Benefits Inc. (DBI) FSA Health Care Reimbursement and the Dependent Care program requires an annual election. This means you must submit a new form even if you are setting aside the same amount as previous years. Through this program, employees are allowed to set aside pre-tax funds in the amount of $5,000 per calendar year ($2,500 if parents are filing taxes separately) for eligible dependent care expenses, or up to the legal limit of $2,650 per calendar year, for eligible health care expenses. DBI will provide all participants a free debit card that can be used for health care expenses, in lieu of requesting reimbursements. A monthly administrative fee will be deducted, in addition to the annual election amount, in the amount of $4.75/month. See the benefits guide provided below, to determine if this is a voluntary benefit you want to elect.

FSA Enrollment Form(PDF, 118KB)
FSA Employee Handout(PDF, 3MB)


Transportation Savings Account (TSA)

Discovery Benefits Inc. will continue to provide a Transportation Savings Account (TSA), also commonly known as a Commuter Check Program. Employees interested in setting aside pre-tax funds for Parking or Mass Transit expenses, are encouraged to apply. There will be no Administrative Fee attached to this benefit, however, if an employee enrolls in the TSA benefit and either FSA program offered by DBI, the administrative fee for the FSA program will be reduced to $4.00/month. See the publications listed below to learn more about the benefits provided by the TSA program.

TSA Enrollment Form(PDF, 122KB)
TSA Benefits Employee Handout(PDF, 821KB)
TSA Parking Summary(PDF, 114KB)


Life Insurance

There is no formal open enrollment period to purchase voluntary supplemental life insurance for yourself and/or your eligible dependents. An Evidence of Insurability is required for all new elections; see form below. Please note that in order to purchase life insurance for your spouse and/or child(ren), you are required to purchase supplemental life insurance for yourself. Rate information is also provided below. This optional benefit is fully paid for by the employee.

This is also the opportunity to update your beneficiary information for your life insurance, including the City-paid Basic Life Insurance.

VOYA Forms
Enrollment at a Glance(PDF, 52KB)
Evidence of Insurability(PDF, 936KB)
Evidence of Insurability(PDF, 565KB) (Instructions)
Beneficiary Designation(PDF, 1003KB)

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