Documents

Benefits Documents

Use these guides to maximize your benefits.

The forms below are designed to be used digitally. Click here for instructions on how to download the forms to your computer so that they are fillable. If you have never electronically signed a document, click here for instructions. Be sure to email your completed form to your department's benefits representative.

Change/Enrollment Forms:

Enrollment Forms:

Claim Forms

File a reimbursement claim using the appropriate form below, or online through your plan account.

Vision out-of-network reimbursement: Log into your account at VSP.com or complete the form here. 

Medical Summaries of Benefits and Coverage

MOST

2023 Aetna Preventive Most
2023 Aetna Traditional Most

2024 Aetna Preventive Most
2024 Aetna Traditional Most

2023 Kaiser Permanente Most Standard
2023 Kaiser Permanente Most Deductible 

2024 Kaiser Permanente Most Standard
2024 Kaiser Permanente Most Deductible 

SPOG

2023 Aetna Preventive SPOG
2023 Aetna Traditional SPOG

2024 Aetna Preventive SPOG 
2024 Aetna Traditional SPOG 

2023 Kaiser Permanente SPOG Standard
2023 Kaiser Permanente SPOG Deductible

2024 Kaiser Permanente SPOG Standard
2024 Kaiser Permanente SPOG Deductible

Local 77

2023 Aetna Preventive Local 77
2023 Aetna Preventive Local 77-Most

2024 Aetna Preventive Local 77
2024 Aetna Preventive Local 77-Most

2023 Aetna Traditional Local 77
2023 Aetna Traditional Local 77-Most

2024 Aetna Traditional Local 77
2024 Aetna Traditional Local 77-Most

2023 Kaiser Permanente Local 77 Standard
2023 Kaiser Permanente Most/Local 77 Standard

2024 Kaiser Permanente Local 77 Standard
2024 Kaiser Permanente Most/Local 77 Standard

Legal and Other Notices

                -  Current Vendor List  (Privacy Notice)

Policies

These policies answer commonly asked questions about benefits eligibility, benefits exceptions, and enrollment deadline exceptions. Talk to your department's Benefits Representative about your situation and how to apply these Exceptions to it.

Rates

Find plan rates, including premium costs and health benefits coverage values to cover a non-IRS tax dependent.

Rate Tables

Retiree Rate Tables

Deferred Compensation Documents

EZ Enroll Form

Beneficiary Form

Additional Forms

Sample QDRO Template

Human Resources

Kimberly Loving, Director
Address: 700 5th Ave, Suite 5500, Seattle, WA , 98124
Mailing Address: PO Box 34028, Seattle, WA, 98124-4028
Phone: (206) 684-7999
Fax: (206) 684-4157
SHR_Info@seattle.gov

The Human Resources Department provides human resource services, tools, and expert assistance to departments, policy makers, employees, and the public so that the City of Seattle's diverse work force is deployed, supported, and managed fairly to accomplish the City's business goals.