Welcome to the 2021 Benefits Page for Public Safety Employees

This is your once-a-year opportunity (outside of a qualifying event) to make medical and dental/vision plan changesChanges made during Open Enrollment take effect January 1, 2021.  

We are offering our Public Safety employees a chance to speak with medical and other benefit carriers virtually. View offerings and availability by vendor at their tab below.
  1. Anthem
  2. Blue Shield
  3. Health Net
  4. Kaiser
  5. OptumRx
  6. Western Health
  7. Nationwide
  8. Dental/Vision
  9. EAP
  10. Life Insurance
  11. ICMA

CalPERS Open Enrollment Step-by-Step Guide



  1. Learn about your health benefit options by watching the above Step-by-Step video guide.
  2. If you wish to make benefit changes for 2021, complete the appropriate enrollment forms. All forms are available in the Forms tab below.
  3. Prior to turning in your CalPERS Health Enrollment Form you must verify your current zip code qualifies under the plan you are selecting. Please visit CalPERS Health Plan Search by Zip Code to do so. CalPERS requires that we capture Social Security numbers for all family members every time a Health Change Form is submitted. When completing your enrollment form, please make sure to include Social Security numbers.
  4. If you plan to enroll in a Flexible Spending Account (Health and/or Dependent Care), you must submit an enrollment form for 2021.Enrollments from 2020 do not automatically enroll you in the 2021 plan year. Health FSA contributions are limited by the IRS to $2,750 per person in 2021 and DCAP contributions to $5,000 per year per eligible family. 
  5. If you would like to take advantage of the one-time opportunity to enroll in or increase your supplemental life and/or AD&D coverages without providing Evidence of Insurability (EOI), complete the required enrollment form. 
  6. Submit all required forms and documentation to Human Resources by the deadline of 5:00pm Friday, October 16, 2020.
  7. Forms not received or postmarked by Human Resources by the deadline will not be processed, no exceptions.
  8. Forms should be e-mailed from your Santa Rosa issued email address to benefits@srcity.org using the “Encrypt” feature under the Options menu in Outlook. WARNING: We do not recommend emailing forms from a personal email. Emailing forms from your personal email could result in a potential security breach of your private information. Forms can also be faxed to (707) 543-3064 or mailed to the following address: Attn: Human Resources Department - Benefits, 100 Santa Rosa Avenue, Room 1, Santa Rosa, CA 95404.
  9. If you do not plan to have an FSA account and do not plan on making any other benefit changes for 2021, no action is needed. Your 2020 medical plan elections will continue into the 2021 plan year (except for FSA elections).
  10. Questions? Contact the Human Resources Department at Benefits@srcity.org or 707-543-3060.

Declining Health Coverage?

Safety employees wishing to waive health coverage because they have other coverage may do so at any time.

Fire -  You may receive the current allotted amount for dependent care, if eligible. Please note that in order to received the allotted amount you MUST have a qualifying dependent and enroll in the Dependent Care Plan for 2021.

Police - You may choose to receive an additional taxed $200 per month OR the current allotted amount for dependent care. Please note that in order to receive the allotted amount for dependent care, you MUST have a qualifying dependent and enroll in the Dependent Care Plan for 2021.

Please provide proof of coverage and complete the following:
  1. Complete the CalPERS Health Benefit Plan Enrollment Form declining coverage 
  2. Complete the Waiver of Health Insurance Form (from the forms tab below)
  3. Provide proof of coverage
  4. Return completed forms and proof of coverage to Human Resources at City Hall, Room 1 no later than 5:00 p.m. Friday, October 23, 2020
  5. Forms not received by Human Resources by the deadline will not be processed, no exceptions. This includes forms mailed but not delivered to Human Resources by the deadline.
  1. 2021 Rates
  2. 2020 Rates

2021 Rates

  1. FAQ's & More!
  2. Forms
  3. Summary of Benefits & Coverage