Employee Benefits

Your Benefits

• Benefits Handbook
• Benefits Outline
• Quick Reference Guide
• Benefits Bulletin
  
  

Health Insurance

• Enrollment Form
• Empire PPO Benefits Booklet
• Certificate of Group Health Plan Coverage
• Consumers Medical Resource Brochure
• MDS Express Flyer
  
  

Vision

• Vision Care Plan Brochure
• TLC Laser Vision Correction Brochure
• Claim Form (Out of Network)
  
  

Dental

• Delta Dental Certificate of Coverage
• Claim Form
• Plan Booklet
• Fact Sheet
  
  

Long-Term Care

• Brochure
  
  

Life Insurance

• Basic and Optional Term Life Insurance Handbook
• Enrollment Kit
• Group Term Life Insurance Portability Election Form
• Short Form Health Statement Questionnaire
• Notice of Group Life Conversion Privilege
• Converting Group Term Life Insurance to Individual Insurance
  
  

Flexible Spending Accounts

• Brochure
• Enrollment Form
• FBMC Direct Deposit Authorization Form
• Reimbursement Request Form

Retirement

• Retirement Plan Summary
• Request for Retirement Credit Based on SUNY Service
• Request for Retirement Credit Based on Prior Non SUNY Employment
• TIAA-CREF Notice of Change of Name Form

FMLA

• Employee Request for Leave Form
• Employee Rights and Responsibilities

Disability Insurance

• Long-Term Disability Certificate of Coverage for Full-Time Employees
• Long-Term Disability Claim Form
• Statement of Rights
• Voluntary Short-Term Disability Certificate of Coverage
• Voluntary Short-Term Disability Enrollment Kit
• Notice and Proof of Claim for Disability Benefits (DB-450)

Worker’s Compensation

• Accident Report