Benefits
Benefit Information
- Helpful Phone #'s/Internet Resources
- Benefits Providers and Summaries
- FMLA *
- Mother's Rooms
- Voluntary Retirement Savings Programs
- Workers' Compensation
- Tuition Support
- EAP (NYS Employee Assistance Program)
Benefit details/Union contracts:
- CSEA (ASU, ISU, OSU)
- PEF (PS&T)
- UUP (PSNU)
- NYSCOPBA (SSU)
- PBANYS (APSU)
- CWA/GSEU (GSNU)
- Management Confidential
Benefit Forms
- Productivity Enhancement Program (PEP) for 2024
- PEP 2024 Overview and Enrollment Form - MC & UUP (enroll 11/1/23-12/11/23)
- PEP 2024 Program Summary - CSEA & PEF
- PEP 2024 Enrollment Form - CSEA & PEF (enroll 11/1/23-12/11/23)
- Health Care Provider Certification for Employee's Serious Health Condition (FMLA) - 3-23
- Health Care Provider Certification for Family Member's Serious Health Condition (FMLA) - 3-23
- Health Insurance Domestic Partner Enrollment Instructions and Form
- MC Life Insurance Statement of Health
- Confidential Medical Statement - April2023
- Health Insurance Transaction Form - PS 404 - Jan 2023
- Health Insurance Transaction Form Documentation Requirements (for PS-404)
- Pre-Tax Contribution Program (PTCP) PTCP Change Chart and PTCP Fact Sheet for NYS Active Employees Enrolled in NYSHIP
- Health Insurance Opt-Out Attestation Form PS409 - August 2019
- NYSHIP Request for Coverage Under the Young Adult Option
- Flexible Spending Account (FSA):
- Americans with Disabilities Act (ADA):
- Military Leave for Combat-related Healthcare Services - Nov 21
PEP 2024 Enrollment Form - CSEA & PEF
2024 PEP Summary & Enrollment Form - UUP & MC
- Retirement at Work Website (Retirement Enrollment & Management System)
- Phased Retirement Program for Full-Time Academic Faculty
- Request for Phased Retirement Form (Faculty)
- Phased Retirement Program for UUP and MC Professionals
- Request for Phased Retirement Form (MC or Professional Staff)
- ERS (Employees' Retirement System) Registration - Form 5420
- TRS (Teachers' Retirement System) Member Application
- Police and Fire Membership Registration - Form PF 5022
- Re-Employment of Retired Public Employees Policy 12-2018)
- RSSL (Retirement System and Social Security Law) Information & Acknowledgement Form
RSSL (Retirement System and Social Security Law) Information & Acknowledgement Form - 2023
- Tuition Assistance - B-140W 2021
- UUP Tuition Assistance (Space Available) - June 2023***
- Tuition Assistance - Technology, Athletic & Health Center Fee Waiver (NP Employees Only)
*** Use this form for classes at SUNY New Paltz. New Paltz employees taking classes at another school should check with that school to see if they have their own form and/or a different process.
Dental Plan Forms:
| Carrier | Group 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 |
| 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:
Retirement and Social Security Law Information & Acknowledgement Form*
