Benefits
Forms & Internet Resources

Dental Plan Forms:

Carrier	Group of Employees	Internet Resource
UUP Benefit Fund/CIGNA	UUP	www.uupinfo.org/benefits/cignaclaim.pdf
CSEA Benefit Fund	CSEA	www.cseaebf.com/library/docs/dentalclaimform.pdf
GHI Dental	M/C, C.82, PEF, GSEU	www.cs.state.ny.us/ebd/ebdonlinecenter /pof/images/epdental.pdf

Vision Plan Information:

Davis Vision	M/C, C.82, PEF, GSEU	Contact Provider at 1-800-999-5431
Davis Vision	UUP	Contact UUP Benefit Fund 1-800-887-3863

Retirement System Forms:

NYS Employees' Retirement System	ALL	www.osc.state.ny.us/retire/forms/ art15membershipapp-RS5420.pdf Membership application Retirement application Change of address form (active members only)
NYS Teachers' Retirement System	UUP, M/C	www.osc.state.ny.us/retire/forms/serviceretirement-RS6037.pdf
Optional Retirement Systems Carriers: ING, MetLife, Valic, TIAA-CREF	UUP, M/C	Contact Human Resources for various forms
Tuition Assistance		Contact Human Resources for various forms

Research Foundation Benefit/Retirement Forms:

Benefit/Retirement forms can be found on the RF Intranet (Access available only on campus to employees)
For additional information contact Jodi Papa in Human Resources at 845-257-3649.

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