Benefits Forms

Dental Plan Forms:

CarrierGroup of Employees
UUP Benefit Fund/Delta Dental UUP
CSEA Benefit Fund* CSEA
GHI Dental* M/C, NYSCOPBA, PBANYS, PEF, GSEU

Vision Plan Information:

CSEA Benefit Fund CSEA 800-323-2732
Davis Vision UUP 800-887-3863
NYS Vision Plan (Davis Vision) M/C, NYSCOPBA, PBANYS, PEF, GSEU 888-588-4823

Retirement System Forms:

NYS Employees' Retirement System* ALL

Membership application
Retirement application
Change of address form (active members only)

NYS Teachers' Retirement System UUP, M/C
SUNY Optional Retirement System investment providers: ING, MetLife, Valic, TIAA-CREF UUP, M/C Contact Human Resources for various forms
Tuition Assistance   Contact Human Resources for various forms

Other Benefits Forms:

Leave Donation Form*

Medical Statement

Retirement and Social Security Law Information & Acknowledgement Form*

 

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