The City of Milpitas annual Open Enrollment period takes place September 10, 2018 through October 5, 2018.  Open Enrollment is your annual opportunity to review and update your current benefits for the upcoming year. You can enroll, change or cancel CalPERS health, dental, vision, Cash-in-Lieu, Flexible Spending Account, or voluntary benefits plans.

The health and well-being of our employees is important, and we encourage you to make sure your benefits work for you.

The effective date for all changes made during the Open Enrollment period will be January 1, 2019.

The deadline to submit Open Enrollment forms to the Human Resources Department is October 5, 2018, at 5:00 p.m. 
All Open Enrollment forms are provided below. Please forward all completed Open Enrollment forms to the Human Resources Department no later than 5:00 pm October 5, 2018.

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 2019 calendar year, a new enrollment form is required.

2019 Health Program Changes

Medical Waiver - Cash in Lieu

The City of Milpitas requires all employees waiving medical coverage to provide proof of health coverage during every Open Enrollment Season. Due to regulations imposed by the Affordable Care Act (ACA) employers with a conditional opt-out arrangement must require employees to provide proof of alternative group health coverage in order to receive cash-in-lieu. Failure to provide evidence of coverage by the designated deadline will postpone the payment of the cash-in-lieu.

Medical Waiver Form

Dental - Delta Dental

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

Milpitas Benefits Enrollment Form

Delta Dental Benefits Summary

Police Delta Dental Benefits Summary

Vision - MES

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

Milpitas Benefits Enrollment Form

Vision Benefits Summary

Flexible Spending Account - Basic Pacific

Enrollment in the Basic Pacific FSA Health Care Reimbursement and the Dependent Care program requires an annual election. 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 $2,550 per calendar year, for eligible health care expenses.  A monthly administrative will be deducted, in addition to the annual election amount, in the amount of $4.85/month.

City of Milpitas-Flex Enrollment Form 2019

Life Insurance - Lincoln Financial Group

You may purchase voluntary supplemental life insurance for yourself and/or your eligible dependents. An Evidence of Insurability is required for all new elections. 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.  This optional benefit is fully paid for by the employee.

You can also take this opportunity to update your beneficiary information for your life insurance, including the City-paid Basic Life Insurance.

Lincoln VTL summary

Lincoln VTL Employee Enrollment

Life Insurance Beneficiary Designation

457 Deferred Compensation Plan - ICMA-RC

ICMA-RC is a non-profit independent financial services corporation providing retirement plans and related services for more than a million public sector participant accounts. Their mission is to help build retirement security for public employees.

Learn more about your 457 Plan by Clicking Here