Documents
Benefits Documents
Use these guides to maximize your benefits.
- 2022 Most Employee Benefits Guide
- En español (Latin American Spanish)
- 2022 SPOG Employee Benefits Guide
- 2022 Local 77 Employee Benefits Guide
- 2022 Fire Fighters Local 27 Employee Benefits Guide
- 2022 Benefits Guide for Temporary Benefits-Eligible Employees
- En español (Latin American Spanish)
- 2022 Exit Guide for Employees Leaving City Employment
- 2022 FSA Guide
- 2022 Most Employee Benefits-at-a-Glance
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
Kaiser Permanente Most Standard 2022
Kaiser Permanente Most Deductible 2022
SPOG
Aetna Preventive SPOG 2022
Aetna Traditional SPOG 2022
Kaiser Permanente SPOG Standard 2022
Kaiser Permanente SPOG Deductible 2022
Local 77
Aetna Preventive Local 77 2022
Aetna Preventive Local 77-Most 2022
Aetna Traditional Local 77 2022
Aetna Traditional Local 77-Most 2022
Kaiser Permanente Local 77 Standard 2022
Kaiser Permanente Most/Local 77 Standard 2022
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
- 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.
- 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.
Rate Tables