ENROLLMENT FORMS
- Health Application (ERB 2000-NYC OLR)
- Optional Riders and Plan Rates (NYC OLR)
- PSC-CUNY: Death Benefits Beneficiary Designation Card
- Adjunct Enrollment Form
- PSC-CUNY: Adjunct Health Plan- Empire
- PSC-CUNY: Adjunct Health Plan-HIP
- GHI HEALTH INSURANCE CLAIM FORM
- GHI STUDENT VERIFICATION PARENT AFFIDAVIT FORM
SUMMARY OF PROGRAM DESCRIPTIONS
- NYC Office of Labor Relations - Summary of Program Description
- PSC–CUNY: Summary of Plan Description - Full Time Active Employees
- PSC–CUNY: Summary of Plan Description - Adjunct Employees
SUMMARY BENEFITS
DENTAL OPTICAL AND PRESCRIPTION BENEFITS
- DC-37 Dental
- DC-37 Optical
- DC-37 Prescription
- PSC-CUNY: Delta Dental
- PSC-CUNY: Guardian
- PSC-CUNY: Optical Plan- General Vision
- PSC-CUNY: Optical Plan- Davis Vision
PENSIONS
- TIAA - CREF
- Teachers Retirement System
- TRS Membership for CUNY Employees
- TRS Designation of QPP Beneficiary
- New York City Employees Retirement System
- Board of Education (Pension *Transfer Contributor)
- IRS Announces Pension Plan Limitations for 2010
RETIREMENT DOCUMENTS
- Application for Retirement
- PSC-CUNY: Retiree Enrollment Questionnaire
- Retiree Change of Address Form
- Monthly Health Plan Rates- Medicare and Non- Medicare Eligible Retirees and Their Dependents
- TIAA-CREF Medicare-Eligible Retirees Application for Medicare (Part B) Reimbursement
UNIONS
- DC-37 (Classified Management and Staff)
- PSC-CUNY: (ECP, HEO, CLT, Faculty and Adjunct)
- PSC-CUNY Member Update
- DC-9 International Brotherhood of Local Painters (Local 1969)
- International Brotherhood of Electrical Workers (Local 3)
- International Brotherhood of Teamsters (Local 237)
- International Union of Operating Engineer (Local 30)
- NYC District Council of Carpenters
- Plumbers of New York City ( Local 1)
- Service Employees International Union (Local 300)
OPTIONAL BENEFITS
COBRA
- COBRA Continuation of Coverage Application
- COBRA Continuation Coverage Election Notice Including Health Plan Rates and Addresses
FMLA
- FMLA Request Form
- FMLA –CUNY Certification of Qualifying Exigency for Military Family Leave
- FMLA- CUNY Certification for Serious Injury of Illness of Covered Service Member for Miltary
- FMLA-Certifcation of Health Care Provider for Employees Serious Health Condition
- FMLA-Certifcation of Health Care Provider for Family Members Serious Health Condition
- HIPPA Authorization for Health Care Provider
TAX DEFERED ANNUITY
- TIAA-CREF Tax Deferred Annuity
- TIAA-CREF Supplemental Retirement Annuity SRA Program
- Halliday Financial Group Tax Deferred Annuity
- Halliday Financial Group Salary Reduction Agreement
- Teachers Retirement System Tax Deferred Annuity
- NYC Deferred Compensation Plan (457B)
- MetLife SRA 2009
TRANSITBENEFITS
- TransitBenefit Enrollment Form and Instruction
- FAQ about TransitBenefit Enrollment Form and Instruction
TUITION FEE WAIVER DOCUMENTS
FLEXIBLE SPENDING ACCOUNTS
- Plan Year 2010 FSA Enrollment/Change Form
- Plan Year 2010 MSC Health Benefits Buy-Out Waiver Enrollment/Change Form
- Plan Year 2010 MSC Premium Conversion Enrollment/Change Form
- Plan Year 2010 HCFSA/DeCAP SPD
- Plan Year 2010 MSC SPD
- Plan Year 2010 HCFSA HIPAA Form
OTHERS
- Domestic Partnership Information Packet
- PSC-CUNY: Long Term Disability Application
- PSC-CUNY: Long Term Disability Questionnaire
- PSC-CUNY: Professional Development (HEO/CLT only)
http://www.psc-cuny.org/HeoCltProfDev.htm
http://www.psc-cuny.org/PDF/HeoCltProfDev.pdf - PSC-CUNY: Perks
- DC-37 Education Benefits
- DC-37 Discounts
- College Savings 529 Plan
- CUNY Emall Perks
- CUNY Work/Life Program
