Intro

This Landing Page is your hub for benefits and human resources information.

Required Notices

In this section you will find a collection of benefit notices that we are required by law to provide to you each year.


  • Premium Assistance Under Medicaid and Children's Health Insurance Program (CHIP)
  • MNSure Exchange Notice
  • HIPAA Special Enrollment Rights
  • Newborns' and Mothers' Health Protection Act
  • Women's Health and Cancer Rights Act
  • HIPAA Notice of Privacy Practices
  • General COBRA Notice


2022 Required Notices

2022 Required Notices

Enrollment

The Benefit choices you make during your initial enrollment or annual open enrollment remain in effect for the entire year. You can, however, modify your elections under certain circumstances, called "Qualifying Events." These are events such as marriage, birth or adoption of a child, or loss of eligibility under another plan. If you experience a qualifying event, you may make changes to your benefits within 30 days of the event or 60 days if the event is due to birth or adoption of a child.


Contact Kim Sommerland if you have questions about qualifying events.

Flexible Benefits Program Election Form 2021

Flexible Benefits Program Election Form 2021

Flexible Benefits Program Election Form 2022

Flexible Benefits Program Election Form 2022

Change in Status Form

Change in Status Form

Cafeteria Plan Document

Cafeteria Plan Document

Benefit Rates

The City provides a flat dollar amount each month that employees can put towards the cost of the benefits they choose to enroll in. For 2022, the amounts are as follows:



2022

$1,175 per month

$1,600 per month for employees electing family medical coverage


Note that Basic Group Term Life is required; all benefit eligible employees must enroll. The cost is $1.70/month for police and city administrator positions and $0.85/month for all other employees.

2022 Benefit Rates

2022 Benefit Rates

Medical

Public Employees Insurance Program

The Public Employee Insurance Program (PEIP) is a health plan available to cities, counties and school districts. PEIP is able to leverage off the state employee plan and use the negotiating clout of their size to offer very low administrative costs and multiple networks. Innovo Benefits is the third party administrator for the plan. Refer to the document below for a step-by-step guide on enrolling in the medical plan.


  • There are three plan design options and three networks to choose from. All options provide preventive care, doctor's visits, hospitalization, and emergency care.
  • Each family member can choose their own primary care clinic (PCC) and your benefit level is based on the cost level of your PCC choice. More efficient, lower cost clinics provide the highest benefit levels. Clinics are broken down into 4 tiers or cost levels.
  • Generally, all routine and non-emergency care flows through your primary care, referrals are typically required for care outside your PCC.
  • Prescription drugs are through the CVS Caremark network for all three network carriers.


Monthly premiums are as follows. If enrolling in the City sponsored HSA plan, or in another qualified high deductible plan, contributions may be made to an HSA.



2022 Single

High Plan $718.60

Value Plan $648.20

HSA Plan $509.62


2022 Family

High Plan $1,872.78

Value Plan $1,684.98

HSA Plan $1,313.86

Instructions for Enrollment

Instructions for Enrollment

Advantage Value Plan Summary

Advantage Value Plan Summary

Advantage HSA Option Plan Summary

Advantage HSA Option Plan Summary

Advantage High Option Plan Summary

Advantage High Option Plan Summary

PEIP Fillable Enrollment Form

PEIP Fillable Enrollment Form

PEIP Change Form

PEIP Change Form

Health Savings Account

Health savings accounts (HSA’s) are a tax-advantaged savings account paired with a high deductible health plan exclusively for the purpose of paying qualified medical, dental and vision expenses for you, your spouse and your dependents. You must be enrolled in PEIP's HSA-compatible plan, or another qualifying high deductible health plan, to be eligible to contribute to an HSA.


At enrollment, you select how much money you want deducted from each paycheck on a pre-tax basis to meet your medical needs. You may change your election throughout the year. The IRS limits the amount of contributions employees are allowed each year, as follows:


2022 Annual Maximum Contribution

  • Employee Only: $3,650
  • Employee + 1: $7,300
  • Family: $7,300


If you are between the ages of 55-65, you can also make an additional $1,000 “catch-up” contribution annually.

Certification of HSA Eligibility 2022

Certification of HSA Eligibility 2022

HSA Enrollment Application

HSA Enrollment Application

Dental

Delta Dental Plan

Delta Dental has the largest dental provider network in Minnesota and the United States. The dental plan utilizes two Delta Dental network options, Delta PPO and Delta Premier, and provides you with the freedom to see any dentist you choose.


Millennium Choice Plan  


Members of Plan Option 1 have the highest level of benefits if they see a dentist who participates in the PPO network, and members of Option 2 have the highest level of benefits if they see a dentist who participates in the Premier network. You may have additional out-of-pocket costs if your dentist is not participating with PPO or Premier. The amount is dependent on the non-participating dentist's charges in relation to Delta's allowable amount.


Monthly Premiums for 2022 are as follows:


Single: $44.55

Single + 1: $86.10

Family: $117.45

Delta Benefit Summary

Delta Benefit Summary

Plan Option 1 Summary

Plan Option 1 Summary

Plan Option 2 Summary

Plan Option 2 Summary

Fillable Enrollment & Change Form

Fillable Enrollment & Change Form

Life

The City provides eligible employees with basic term life and accidental death and dismemberment (AD&D) coverage.


Minnesota Life Insurance

The life benefit is payable to your designated beneficiary in the event of your death. You can apply for insurance up to $300,000 for yourself, and up to $150,000 for your spouse. Eligible children can be covered up to $10,000. AD&D benefits are payable to you in the event of a dismemberment or an additional benefit is payable to your beneficiary if your death is the result of an accident. Employee and spouse monthly age-banded rates are as follows, each rate is per $1,000 of benefit.


Age

< 25: $0.08

25-29: $0.09

30-34: $0.11

35-39: $0.12

40-44: $0.15

45-49: $0.24

50-54: $0.40

55-59: $0.64

60-64: $0.78

65-69: $1.34

70-74: $2.09


Cost for child life insurance, covering all eligible children, is $1.30 per month, per each $10,000 of benefit.


NCPERS Life Insurance

Group decreasing term life insurance offered through the National Conference on Public Employees Retirement Systems (NCPERS). Note there is no new enrollment at this time for this plan.


Who's Your Beneficiary? Naming a beneficiary is a crucial part of electing life insurance. Also, don't forget to update your primary or secondary beneficiary if you experience a life event, such as a divorce or birth of a child.

MN Life Application

MN Life Application

MN Life Beneficiary Designation Form

MN Life Beneficiary Designation Form

Long Term Disability

Long Term Disability (LTD) insurance provides financial protection in case of a long-term disability. Benefits begin on the 91st day of a disability and are payable for injury, sickness or pregnancy up to your normal retirement age, as defined by Social Security. You my elect any level of coverage, in increments of $100 between $500 and $5,000 per month, provided you don't insure more than 60% of your monthly income. Monthly age-banded rates are as follows, each rate is per $100 of benefit.


Age

< 25: $0.23

25-29: $0.23

30-34: $0.35

35-39: $0.53

40-44: $0.54

45-49: $1.07

50-54: $1.55

55 + : $2.12


LTD Benefit Summary

LTD Benefit Summary

Rate Calculation Form

Rate Calculation Form

LTD Evidence of Insurability

LTD Evidence of Insurability

LTD Enrollment Form

LTD Enrollment Form

Aflac Benefits

The City provides a competitive benefits package for all employees as part of our total compensation package. We realize you make benefit choices based on what’s important to you and the needs of your changing lifestyle. Therefore, along with our core benefits, we offer these additional benefits which help to provide financial support. A brief description of each benefit follows below.


  • Accident Insurance
  • Cancer/Specified Disease
  • Voluntary Dental
  • Hospital Confinement Indemnity
  • Hospital Intensive Care
  • Life Insurance
  • Hospital Confinement Sickness Indemnity
  • Voluntary Short Term Disability
2021 Monthly Aflac Rates

2021 Monthly Aflac Rates

Product Overview

Product Overview

Accident Insurance

Accident Insurance is a way to stay ahead of the medical and out of pocket expenses that add up after accidental injuries and their treatment. Accident Insurance can pay a benefit amount based on the type of injury you have and the type of treatment you need. It covers accidents that occur on and off the job, and it includes a range of incidents, from common injuries to more serious events.

Cancer/Specified Disease

No one wants to experience a cancer diagnosis, but the fact is that the risk of getting cancer is real. Aflac cancer/specified disease insurance policy is designed to provide you with cash benefits during covered cancer treatments.

Voluntary Dental

Aflac's dental insurance allows you to stay with your current dental provider, or choose any dentist without any network restrictions. The plan doesn't require you to meet an out of pocket deductible for the year. Instead, after applicable waiting periods the plan will pay benefit starting with the first covered treatment.

Hospital Confinement Indemnity

Hospital Insurance helps covered employees and their families cope with the financial impacts of a hospitalization. You can receive benefits when you're admitted to the hospital for a covered accident, illness, or childbirth. The money is paid directly to you - not to a hospital or care provider. The money can also help you pay the out-of-pocket expenses your medical plan may not cover, such as co-insurance, co-pays and deductibles.

Hospital Intensive Care

Aflac's intensive care policy provides cash benefits for accidents or illnesses that result in admittance to the hospital's intensive care unit. These cash benefits are paid directly to you, unless you instruct Aflac to direct them elsewhere.

Voluntary Life

Life Insurance through Aflac can provide money for your family to take care of your loved one's immediate and future needs following your death. There is a variety of options to suit your need and income:


Term Life - provides a death benefit for a specific length of time, usually 20 or 30 years. Coverage expires at the end of the term.

Whole Life - offers a death benefits plus n investment component. The policy man remain in force for a lifetime, provided the premiums are paid.

Term Life Riders - a rider may be added to cover children, if desired.


Naming a beneficiary is a crucial part of electing life insurance. Also, don't forget to update your primary or secondary beneficiary if you experience a life event, such as a divorce or birth of a child.

Hospital Confinement Sickness Indemnity

Aflac's Hospital Confinement Sickness plan help ease the financial burden of hospital stays due to illness by paying a cash benefit. While the primary benefits of the policy pay for hospital care, there's also a physician visit feature for those times when you're sick or need a routine exam.

Short Term Disability

Short Term Disability Insurance can pay you a weekly benefit if you have a covered disability that keeps you from working and can replace part of your income while you recover. As long as you remain disabled, you can continue to receive benefits. You have a choice of coverage amount and benefit duration. This insurance may cover a variety of conditions and injuries -- but might not cover pre-existing conditions. Check the policy for details.


LegalShield

LegalShield

LegalShield offers both a legal plan and identity theft plan. The legal plan provides access to advice from attorneys to address personal legal issues, including but not limited to, speeding ticket assistance, contract review, IRS audit assistance, and will preparation. Some of the features of the identity theft plan include social media monitoring, privacy and security monitoring, consultation, and full identity restoration. Click below to see a short video on how LegalShield can help. Monthly rates for the two plans are shown below:


Single

  • ID Shield: $8.96
  • Legal Shield: N/A
  • ID/Legal Shield combined: $27.90

Family

  • ID Shield: $18.96
  • Legal Shield: $18.96
  • ID/Legal Shield combined: $33.90


Grandfathered rates for employees already enrolled in legal and ID protection plans:

Single

  • ID Shield: $8.96
  • Legal Shield: $16.96
  • ID/Legal Shield combined: $25.90

Family

  • ID Shield: $18.96
  • Legal Shield: $18.96
  • ID/Legal Shield combined: $33.90

Retirement Savings Plans

457(b) Deferred Compensation

A 457(b) Deferred Compensation plan provides employees the opportunity to save for retirement on a tax-favored basis. Federal and state income taxes are deferred until funds are withdrawn. Plans to which City employees may contribute include:


  • MN State Retirement System (MSRS)/MN State Deferred Comp Plan (MNDCP)
  • Edward Jones/John Hancock Funds


Pension

City employees are required by State law to participate in pension plans administered by the Public Employees Retirement Association (PERA). These plans provide pension, disability, and survivor benefits that are based on your earnings history and covered service with the City (and other public employers). Both the employee and City contribute a percentage of employee wages to fund future benefits. Contribution rates are set by State law and change periodically to reflect changes in benefits and funding needs.

MNDCP Beneficiary Designation Form

MNDCP Beneficiary Designation Form

MNDCP Participant Enrollment Form

MNDCP Participant Enrollment Form

John Hancock Enrollment Packet

John Hancock Enrollment Packet

Health Care Savings Plan

Eligible employees can save money, tax-free, to pay for eligible health care expenses through the Health Care Savings Plan (HCSP) administered by the Minnesota State Retirement System (MSRS). Participation is determined by employee group. If a bargaining unit chooses to participate, then all employees in that bargaining unit must contribute to the plan as agreed upon by the group. Deductions can be made from regular wages and/or from vacation or sick leave severance pay.


Funds may be withdrawn to reimburse medical expenses if an individual leaves employment with the City, retires, elects PERA's Phased Retirement Option (PRO), collects a disability from a Minnesota public pension plan, has been on medical leave for six months or longer, or has been on a leave of absence for one year or longer.

HCSP Beneficiary Designation

HCSP Beneficiary Designation

HR Documents

This section holds a collection of commonly used HR forms for you to print and complete.

Employee Handbook & Safety Program Documents

Employee Handbook

Employee Handbook

St. Paul Park Safety Program

St. Paul Park Safety Program

Accounting & Payroll

Direct Deposit Authorization

Direct Deposit Authorization

Fillable Expense Reimbursement Form

Fillable Expense Reimbursement Form

FORM I-9

FORM I-9

Form W-4

Form W-4

Form W-4MN

Form W-4MN

Tennessen Warning Form Benefits & Payroll

Tennessen Warning Form Benefits & Payroll