Benefits Information
Welcome to the City of Pomona’s, Benefits Division web page. This web site will allow you access to information on the benefits the City of Pomona offers its eligible employees.
The City of Pomona offers a comprehensive benefits package consisting of Medical, Dental, Life Insurance, Disability Insurance, Retirement and Voluntary Plans. This site will provide you with information regarding the City’s health plans, voluntary plans and retirement.
Benefit Information Topics:
BENEFIT CONTACT INFORMATION:
Chris Munoz, Technical Specialist II
Phone- 909-620-2393
Fax- 909-620-2295
E-mail:
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Sandra Piva, Human Resources Manager
Phone – 909-620-2004
Fax – 909-620-2295
Email:
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Please click on the following link for important group numbers, phone numbers, and website addresses.
NOTICE: The City of Pomona, Human Resources Department conducts official City business electronically as well as through traditional means. Any document requiring a signature will be considered legally signed with a typed signature.
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Form Name
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Purpose
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Instructions
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Forms Necessary to Enroll or Make Changes to Insurance Plans:
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HBD12
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To enroll or make changes to health plans.
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If you have medical coverage and want to opt out and enroll in the Cash-In-Lieu program, you must complete the HBD12-A form and the Dental, Vision and Cash-In-Lieu Enrollment Form.
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HBD12 – A
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To decline health insurance. *All new hires must complete this form.
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In addition to this form, you must also complete the Dental, Vision and Cash-In-Lieu Enrollment Form.
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Death Benefit Fund
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To enroll or make changes to the Death Benefit Fund program or beneficiaries.
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Enrollment into this program can be done at any time during employment.
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Dental, Vision & Cash-In-Lieu
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To enroll or make changes to Dental, Vision or Cash-In-Lieu.
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Life Insurance
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To enroll or make changes to the City-paid or additional voluntary life insurance plan or beneficiaries.
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Forms Necessary to Request Benefits Under Other Policies/Programs:
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Catastrophic Request
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To request donations.
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This links will take you to the policy which includes the request form.
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FMLA - Request Form.
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To request FMLA leave.
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FMLA - Medical Certification for Employees
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To certify that employee has a serious health condition.
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This form must be submitted with the FMLA Request form if request is for employee.
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FMLA - Medical Certification for Family Members
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To certify that family member has a serious health condition.
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This form must be submitted with the FMLA Request Form if request is for a family member.
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FMLA – Return to Work
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To certify that employee has been released to return to work.
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This form must be submitted before or on the day employee wishes to return to work.
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This option allows eligible employees to waive medical insurance in exchange for cash if they can provide Human Resources with satisfactory proof that they are covered by a medical plan comparable to the City’s medical insurance.
In 2012 the amounts of the Cash in Lieu of Medical are as follows:
- For General Service, Mid Mgmt/Conf, PPMA and PPOA the amount is $429.22 per month.
- For groups A and B the amount is $544.69 per month.
This amount can be either taken as cash or invested in the City’s Deferred Compensation Program through payroll deduction. Please contact Human Resources for required documentation.
For the enrollment form, please click here.
DEATH BENEFIT FUND PROGRAM:
The City of Pomona recognizes that an untimely death of an employee may create unexpected financial obligations and that individual life policies are often delayed beyond the time of immediate need; therefore, this voluntary plan is available and funded by the participating employees contributions. This is a voluntary plan and employees can enroll at any time during employment.
The City provides all employees the opportunity to enroll in a Section 457 Deferred Compensation plan. Deferred Compensation allows participants to defer a portion of their salary, pretax for investment purposes. The City currently offers the following plan: Hartford Life Insurance. Interested employees must contact the plan representative directly.
Please click on the following link for contact information:
The City provides eligible employees with the choice between two plans: Delta Dental, indemnity plan and, Dental Health Services (DHS), a pre-paid dental plan. The City pays up to seventy-five dollars ($75) per month towards dental insurance for full time General Service Employees, Mid Mgmt/Conf Group and Executive Management, Pomona Police Managers’ Association and Pomona Police Officers’ Association represented employees, $56.25 per month for library employees working 75% timebase and $37.50 per month for Library employees working 50% timebase.
For More information about the plans click on the links below:
Please click on the following link for dental plan rate information and plan comparison:
For the enrollment form, please click
here.
DEPENDENT ELIGIBILITY REQUIREMENTS:
Eligible dependents include the following: Legally married spouses, registered domestic partners, natural children, adopted children, step children and children of registered domestic partners.
Please click on the following link for detailed information.
The City provides eligible employees with fully paid disability insurance. There is a 60-day elimination period.
Please click on the following link for disability insurance coverage amounts bargaining unit or group.
EMPLOYEE ASSISTANCE PROGRAM (EAP):
The City's Employee Assistance Program (EAP) offers free, confidential, professional counseling to employees and their immediate families. This program provides confidential professional assistance to help employees and their families resolve problem that affect their personal lives or job performance.
Please click on the following link for more detailed information:
FLEXIBLE SPENDING ACCOUNT:
The City’s Section 125 Flexible Spending Plan for out-of pocket Health related expenses and Dependent Care cost is currently administered by Aflac. This plan allows employees to redirect a portion of their salaries to pay for the expenses on a pre-tax basis. Aflac also offers voluntary benefits such as Cancer Insurance and hospital insurance..
Please contact Aflac at 1-800-99-AFLAC for additional information.
LIFE INSURANCE- CITY PAID:
The City provides a fully paid group life insurance to all eligible employees. Benefit level is based on bargaining unit or group.
Please click on the following link for life insurance coverage amounts by bargaining unit or group:
For the enrollment form, please click
here.
LIFE INSURANCE- VOLUNTARY:
The City provides you the opportunity to purchase Voluntary Life Insurance at a group rate.
Please Click on the following link for additional information including rates.
For the enrollment form, please click
here.
IMPORTANT ENROLLMENT INFORMATION:
As a new employee or current employee you have certain restrictions regarding enrollment into benefits and making changes to your benefits.
Please click on the following link for detailed information:
The City of Pomona contracts with the California Public Employees’ Retirement System (CalPERS) for medical insurance. CalPERS currently offers seven (7) health plans for our eligible employees, three (3) Health Maintenance Organization (HMO) plans and four (4) Preferred Provider plans. The City pays up to seven hundred dollars ($700) per month towards medical insurance for General Service Employees, Mid Mgmt/Conf Group and Executive Management employees, Pomona Police Managers’ Association (PPMA) and Pomona Police Officer’s Association (PPOA) represented employees. (All regular full-time employees)
- CalPERS Health Program Guide - This guide will provide you with helpful information regarding eligibility and other information. Did you know you have 60 days from date of marriage to add your spouse to your health plan and that your children may be on your health plan until age 26?
- 2012 Health Benefit Summary - Get information regarding all the CalPERS HMO and PPO Health Plans. Learn about the tools available to help you choose your Health Plan.
- 2012 Evidence of Coverage Booklets - This link will take you to CalPERS where you will locate links to the evidence of coverage booklets for all the health plans offered by the City.
Please click on the following link for rate information:
For the enrollment form, please click here.
An employee married to another City of Pomona employee may combine the City’s contribution for medical insurance to pay for the cost of medical insurance that exceeds the City’s contribution, currently seven hundred dollars ($700) per month. Any balance remaining after the City’s contribution will not be reimbursed to the employee.
Married City employees may also choose to be covered under one spouse’s City insurance plan and the other spouse may enroll in Cash in Lieu of Medical and receive cash back or invest the money into the City’s Deferred Compensation Program.
Open Enrollment is the period during which eligible employees may request to enroll, change plans, or add eligible family members who are not currently enrolled. Open Enrollment is held every year, usually in the Fall. The effective date for Open Enrollment transactions is January 1st of the following year.
The City contracts with Safeguard Vision to provide a voluntary plan to eligible City employees. Safeguard provides for one eye exam and standard frames and lenses every 12 months. This is a voluntary plan and is fully paid by employees.
Please click on the following link for the rate information and plan summary:
For the enrollment form, please chick
here.
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