All employees are automatically enrolled in the city-paid Basic Life insurance benefit, as designated in the appropriate MOU, upon hire. Employees should maintain an updated Basic Life Beneficiary Designation form on file.
There is no formal open enrollment period to purchase Voluntary Life insurance for yourself and/or your eligible dependents. Please note that in order to purchase life insurance for your spouse and/or child(ren), you are required to purchase voluntary life insurance for yourself. Evidence of Insurability is required for all new elections (outside of the 30-day window from date of hire); see form below. This optional benefit is fully paid for by the employee.
Cigna Life Insuarance Forms
- Basic Life and ADD Beneficiary Designation Form
- Voluntary Life Insurance Application
- Voluntary Life Insurance brochure
- Voluntary Life Insurance Sample Rate Sheet
- How To File A Disability Claim & Process
- Financial Legal & Estate Support Flyer
- Employee Assistance & Wellness Support Flyer
Certificates of Coverage:
- LTD
- Class 1 All Employees – lk960715c01
- Class 2 Safety Management – lk960715c02
- Class 4 Executive Management – lk960715c04
- Class 5 Mid-Management – lk960715c05
- Class 6 City Manager – lk960715c06
- LTD, ERISA Amendment
- Life Insurance
- Open Enrollment Jan – June 2015 – FLX960830a02rei1013
- Class 1 All Employees – FLX960830c01rei1013
- Class 2 Safety Mid-Management – FLX960830c02rei1013
- Class 3 Councilmembers – FLX960830c03rei1013
- Class 4 Executive Management – FLX960830c04rei1013
- Class 5 Mid-Management – FLX960830c05rei1013
- Class 6 City Manager – FLX960830c06rei1013
- Continuation of coverage – FLX960830a03rei1013
- Life Insurance, ERISA Amendment
LTD – Benefit Summary Flyers ( LK960715)
- Class 1 All Employees – City-of-San-Rafael-BLTD-Benefit-Highlight-Sheet-C1
- Class 2 Represented Management – City-of-San-Rafael-BLTD-Benefit-Highlight-Sheet-C2
- Class 4 Executive Management – City-of-San-Rafael-BLTD-Benefit-Highlight-Sheet-C4
- Class 5 Mid-Management – City-of-San-Rafael-BLTD-Benefit-Highlight-Sheet-C5
- Class 6 City Manager – City-of-San-Rafael-BLTD-Benefit-Highlight-Sheet-C6
Basic Life Benefit Summary Flyers (LK960715)
- Class 1 All Employees
- Class 2 Safety (Rep) Mgmt
- Class 3 Councilmembers
- Class 4 Management
- Class 5 Mid-Management
- Class 6 City Manager
*The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that sets minimum standards for most voluntarily established retirement and health plans in private industry to provide protection for individuals in these plans.*