Benefit Forms
- CSEA Dental Claim Form (PDF) * or (Text)
- MC Dental Claim Form (GHI) (PDF) * or (Text)
- UUP Dental and Vision Forms
- Civil Service Online Forms
- Regular Employee Health Insurance Enrollment Form (PS404) (PDF) * or (Text)
- HMO Enrollment Form (PDF) * or (Text)
- Graduate Student Health Insurance Enrollment Form (PDF) * or (Text)
- Empire Plan Out-of Network Claim Form (PDF) * or (Text)
- Sick Leave Credit Election (Dual Annuitant) (PDF) * or (Text)
- Deferred Health Insurance for Retirees (Indefinitely) (PDF) * or (Text)
- Sick Leave Credit Preservation (PDF) * or (Text)
- Health Insurance and Dental/Vision Insurance
for Employees on Leave Without Pay (PDF) * or (Text) - LWOP Health Insurance Remittance Notice (PDF) * or (Text)
- Family LWOP Health Insurance Remittance Notice (PDF) * or (Text)
- Waiver of Premium Application (PDF) * or (Text)
- Statement of Dependence (PDF) * or (Text)
- Application for a Reduced Maximum Out-of-Pocket Co-insurance Expense (PDF) * or (Text)
- Coordination of Benefits (PDF) * or (Text)
- Dependent COBRA Request Letter (DOC) or (Text)
- Dependent COBRA Request Letter (Graduating) (DOC) or (Text)
- Retirement History Form (PDF) * or (Text)
- Retirement Election Form (ORP-1) (PDF) * or (Text)
- ORP Public Retirement System Determination (ORP-4) (PDF) * or (Text)
- Retirement Plan Booklet (PDF) * or (Text)
- Salary Reduction Agreement (PDF) * or (Text)
- TIAA-CREF Retirement Forms
- Teachers' Retirement System Forms
- Vision Forms
- Davis Vision Out of Network Claim Form (PDF) * or (Text)
Disability Forms