ENROLLMENT FORMS
- Health Application (ERB 2000-NYC OLR)
- Optional Riders and Plan Rates (NYC OLR)
- Young Adult Health Benefits Coverage Instruction Sheet Employees
- PSC Enrollment Form
- PSC-CUNY: Death Benefits Beneficiary Designation Card
- GHI HEALTH INSURANCE CLAIM FORM
- DC37 Enrollment Card
- DC37 Change of Status
ADJUNCTS
- For Your Benefit
- PSC–CUNY: Summary of Plan Description - Adjunct Employees
- Adjunct Health Insurance Enrollment Form
- PSC-CUNY: Adjunct Health Plan- Empire
- PSC-CUNY: Adjunct Health Plan-HIP
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
- Classified Managerial Staff – Benefits at a Glance
SUMMARY BENEFITS
- CUNY Summary of Benefits for ECP Staff
- CUNY Summary of Benefits for Full Time Staff
- Classified Managerial Staff Benefits at a Glance
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
- NYCERS
- Board of Education (Pension *Transfer Contributor)
- IRS Announces Pension Plan Limitations for 2011
RETIREMENT DOCUMENTS
- Retirement Procedures
- Application for Retirement
- Health Application (ERB 2000-NYC OLR)
- PSC Retiree Enrollment form
- 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
- TIAA-CREF Lifetime income annuity
- SS - How to Create an Online Account
- SS - What You Can Do Online
UNIONS
- DC-37 (Classified Management and Staff)
- PSC-CUNY: (ECP, HEO, CLT, Faculty and Adjunct)
- 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
DEDICATED SICK LEAVE
- Dedicated Sick Leave Article
- Dedicated Sick-Leave Program (pdf)
- Application Donate Dedicated Sick-Leave (pdf)
- Application to Receive Dedicated Sick Leave (pdf)
COBRA
FMLA
- CUNY POLICY ON FAMILY & MEDICAL LEAVE ACT
- FMLA Request Form
- FMLA-Certification of Health Care Provider for Employees Serious Health Condition
- FMLA-Certification of Health Care Provider for Family Members Serious Health Condition
- FMLA- CUNY Certification for Serious Injury of Illness of Covered Service Member for Miltary
- FMLA –CUNY Certification of Qualifying Exigency for Military Family Leave
- HIPPA Authorization for Health Care Provider
PAID PARENTAL LEAVE
TAX DEFERED ANNUITY
- Salary Reduction Agreement - TIAA CREF, HRC or Metlife
- Teachers Retirement System Tax Deferred Annuity
- NYC Deferred Compensation Plan (457B)
TRANSITBENEFITS
- Wage Works CBP Cover Letter
- Wage Works Transit Benefit Enrollment Form
- CUNY Transit Benefit Program
- Park-n-Ride Plan Enrollment Form Senior College
TUITION FEE WAIVER DOCUMENTS
FLEXIBLE SPENDING ACCOUNTS
- Plan Year 2013 Brochures and Enrollment/Change Forms
- Plan Year 2013 Flexible Spending Accounts Program Brochure
- Plan Year 2013 FSA Enrollment/Change Form
- Plan Year 2013 MSC Health Benefits Buy-Out Waiver Enrollment/Change Form
- Plan Year 2013 MSC Premium Conversion Enrollment/Change Form
- Plan Year 2013 HCFSA/DeCAP SPD
- Plan Year 2013 MSC SPD
- Plan Year 2013 HCFSA HIPAA Form
- HCFSA Medical Necessity Form
- FSA Direct Deposit Form
- DEPENDENT CARE ASSISTANCE PROGRAM (DeCAP)
- HEALTH CARE FLEXIBLE SPENDING ACCOUNT (HCFSA)
- HCFSA Mid Year Enrollment Memo
OTHERS
- Domestic Partnership Information Packet
- PSC-CUNY: Domestic Partnership Information Packet
- PSC-CUNY: Long Term Disability Application
-
PSC-CUNY: Long Term Disability Questionnaire
NY residents, NJ residents, CT residents, PA residents
Payroll Deduction Authorization card
- PSC-CUNY: Professional Development (HEO/CLT only)
PSC Proffesional Development
- PSC-CUNY: Perks
- DC-37 Education Benefits
- DC-37 Discounts
- College Savings 529 Plan
- CUNY Emall Perks
- CUNY Work/Life Program
- TIAA-CREF Elimination of Employee Contribution
- Young Adult Coverage through age 29
- The Standard Life Insurance Company of New York
