Open Enrollment Retiree Benefits

2022 Open Enrollment starts October 4, 2021 and ends Friday, October 29, 2021!

PERSONAL INFORMATION
CONTACT INFORMATION
EMERGENCY CONTACT
BENEFITS

Form Title

Open Enrollment Retiree Benefits

1. MEDICAL

An HR representative will contact you for a copy of your or your spouse's Medicare card.

As a City of Sacramento retiree, eligible for retiree medical benefits, you may request a monthly reimbursement from the City of Sacramento for individual medical premiums. If you select dental and/or vision coverage with the City of Sacramento the monthly premium(s) will be subtracted prior to calculating your reimbursement amount. If electing Cash in-lieu for 2022, additional information and forms will be mailed to you for completion.

2. DENTAL
3. VISION

If you need to complete a carrier enrollment form, the form will be mailed to you after we have reviewed your OE form. The due date to submit the carrier form back to the City is November 12, 2021.

Open Enrollment Retiree Benefits

Dependents

Please list all dependents even if you are not making changes to your benefits.

Proof documentation for dependent eligibility is due by November 12, 2021.

Summary

Open Enrollment Retiree Benefits

Form Title

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Open Enrollment Retiree Benefits

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