Documents
Benefits Documents
Use these guides to maximize your benefits.
- 2021 Most Employee Benefits Guide
- En español (Latin American Spanish)
- 2021 SPOG Employee Benefits Guide
- 2021 Local 77 Employee Benefits Guide
- 2021 Benefits Guide for Temporary Benefits-Eligible Employees
- En español (Latin American Spanish)
- 2021 Exit Guide for Employees Leaving City Employment
- 2021 FSA Guide
- 2021 Most Employee Benefits-at-a-Glance
- En español (Latin American Spanish)
- 简化字 (Simplified Chinese)
- bằng tiếng Việt (Vietnamese)
- 正體字 (Traditional Chinese)
- Af Soomaali (Somali)
- 한국어 (Korean)
- sa Tagalog (Tagalog)
- 2021 SPOG Employee Benefits-at-a-Glance
- En español (Latin American Spanish)
- 简化字 (Simplified Chinese)
- bằng tiếng Việt (Vietnamese)
- 正體字 (Traditional Chinese)
- Af Soomaali (Somali)
- 한국어 (Korean)
- sa Tagalog (Tagalog)
- 2021 Local 77 Employee Benefits-at-a-Glance
- En español (Latin American Spanish)
- 简化字 (Simplified Chinese)
- bằng tiếng Việt (Vietnamese)
- 正體字 (Traditional Chinese)
- Af Soomaali (Somali)
- 한국어 (Korean)
- sa Tagalog (Tagalog)
- 2021 Temporary Benefits Eligible Employee Benefits-at-a-Glance
- En español (Latin American Spanish)
- 简化字 (Simplified Chinese)
- bằng tiếng Việt (Vietnamese)
- 正體字 (Traditional Chinese)
- Af Soomaali (Somali)
- 한국어 (Korean)
- sa Tagalog (Tagalog)
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:
- Accidental Death and Dismemberment Insurance
- Add Dependents
- Affidavit of Marriage/Domestic Partnership
- Flexible Spending Accounts Enrollment
- Flexible Spending Accounts Change
- Group Term Life Insurance
- Remove Dependents
- Statement of Marriage/Domestic Partnership Termination
- Supplemental Long-Term Disability Insurance
Enrollment Forms:
Claim Forms
File a reimbursement claim using the appropriate form below, or online through your plan account.
- Accidental Death and Dismemberment Claim: contact the Benefits Unit at Benefits.Unit@seattle.gov or (206) 615-1340
- Aetna Medical Claim Form
- Delta Dental of Washington Claim Form
- Flexible Spending Account Claim Reimbursement Form
- Group Term Life Accelerated Death Benefit Claim: contact the Benefits Unit at Benefits.Unit@seattle.gov or (206) 615-1340
- Group Term Life Death Claim: contact the Benefits Unit at Benefits.Unit@seattle.gov or (206) 615-1340
- Long Term Disability Claim Filing Instructions
Vision out-of-network reimbursement: Log into your account at VSP.com.
Medical Summaries of Benefits and Coverage
MOST
Aetna Preventive Most 2022
Aetna Traditional Most 2022
Aetna Preventive Most 2021
Aetna Traditional Most 2021
Kaiser Permanente Most Standard 2022
Kaiser Permanente Most Deductible 2022
Kaiser Permanente Most Standard 2021
Kaiser Permanente Most Deductible 2021
SPOG
Aetna Preventive SPOG 2022
Aetna Traditional SPOG 2022
Aetna Preventive SPOG 2021
Aetna Traditional SPOG 2021
Kaiser Permanente SPOG Standard 2022
Kaiser Permanente SPOG Deductible 2022
Kaiser Permanente SPOG Standard 2021
Kaiser Permanente SPOG Deductible 2021
Local 77
Aetna Preventive Local 77 2022
Aetna Preventive Local 77-Most 2022
Aetna Preventive Local 77 2021
Aetna Preventive Local 77-Most 2021
Aetna Traditional Local 77 2022
Aetna Traditional Local 77-Most 2022
Aetna Traditional Local 77 2021
Aetna Traditional Local 77-Most 2021
Kaiser Permanente Local 77 Standard 2022
Kaiser Permanente Most/Local 77 Standard 2022
Kaiser Permanente Local 77 Standard 2021
Kaiser Permanente Most/Local 77 Standard 2021
Legal and Other Notices
- Medicaid and the Children's Health Insurance Program
- Continuation Coverage Rights Under COBRA
- Credible Coverage Disclosure
- City of Seattle Privacy Policy
- Resources for Living Privacy Policy
- Vision Provider Privacy Policy
- Dental Health Services Privacy Policy
- Women's Health and Cancer Rights Notice
- Privacy Notice
- Vendor List (Privacy Notice)
Policies
These policies answer commonly asked questions about benefits eligibility, benefits exceptions, and enrollment deadline exceptions. See your department's Benefits Representative to talk about your situation and how to apply these Exceptions to it.
- Benefits eligibility
- Benefits exceptions policy
- Enrollment deadline exceptions
Rates
Find plan rates, including premium costs and health benefits coverage values to cover a non-IRS tax dependent.
- 2021 All Plan Rates
- 2022 All Plan Rates
- 2021 Non-IRS Tax Dependents Coverage Values
- 2022 Non-IRS Tax Dependents Coverage Values
Rate Tables