| |
How Benefits Are Affected When Employment Terminates |
| |
Status of Your Benefits Upon Termination - Full-time Faculty and Administrative Staff (PDF) |
|
2013 COBRA Rates - Full-time Faculty and Administrative Staff Plans (PDF) |
| |
Status of Your Benefits Upon Termination - Part-time Faculty (PDF) |
|
2013 COBRA Rates - Part-time Faculty Plans (PDF) |
| |
Statement of Domestic Partnership |
| |
Statement of Domestic Partnership (PDF) |
|
|
| |
Dental Care Plans (Delta Dental) |
| |
PPO Plan Reimbursement Claim Form (PDF)
|
|
DeltaCare (DHMO) Summary of Benefits (PDF) |
| |
Enrollment/Change Form - Full-Time Faculty and Administrative Staff (PDF) |
|
Dental PPO Plan Summary (PDF) |
| |
Enrollment/Change Form - Part-Time Faculty (PDF)
|
|
|
| |
Flexible Spending Accounts (EBPA) |
| |
IRS Eligible Expenses (PDF) |
|
Direct Deposit Form (PDF) |
| |
Over-The-Counter Items Eligible for Reimbursement |
|
Dependent Care Expenses Cost Estimation Worksheet (PDF) |
| |
Dependent Care Claim Form (PDF) |
|
Health Care Expenses Cost Estimation Worksheet (PDF) |
| |
Health Care Claim Form (PDF) |
|
Additional Benefits Card Request Form (PDF) |
| |
Health Care Plan |
| |
Health Care Enrollment/Change Form for Full-Time Faculty and Administrative Staff (PDF) |
|
Health Care Enrollment/Change Form for Part-Time Faculty (PDF) |
| |
Summary Plan Description (SPD) - Choice EPO (PDF) |
|
Summary of Benefits and Coverage (SBC)- Choice EPO (PDF) |
| |
Summary Plan Description (SPD) - Choice Plus 1000 (PDF) |
|
Summary of Benefits and Coverage (SBC)-Choice Plus 1000 (PDF) |
| |
Summary Plan Description (SPD) - Choice Plus 500 (PDF) |
|
Summary of Benefits and Coverage (SBC)- Choice Plus 500 (PDF) |
| |
Summary Plan Description (SPD) - High Deductible Health Plan (PDF) |
|
Summary of Benefits and Coverage (SBC)- High Deductible Health Plan (PDF) |
| |
UnitedHealthcare Reimbursement Claim Form (PDF) |
|
UnitedHealthcare Reimbursement Claim Form For Mental Health Services Only (PDF) |
| |
UnitedHealthcare's Health Discounts Program (PDF) |
|
The New School Health Plan Notice of Privacy Practices—Self-Funded Plans (PDF) |
| |
UnitedHealthcare Vision Plan
|
|
Prescription Drug Coverage
|
| |
Health Saving Account Application (PDF) (available only if enrolled in the High Deductible Health Plan) |
|
Health Saving Account - Employee Contribution Form (PDF) (available only if enrolled in the High Deductible Health Plan) |
| |
Life Insurance Plan (The Standard Life Insurance Company of NY) |
| |
Life Insurance Beneficiary Designation Form (PDF) |
|
(PDF) |
| |
Long Term Care Information |
| |
Long Term Planning Associates, LLC (PDF) |
|
|
| |
Long-Term Disability Plan (The Standard Life Insurance Company of NY)
|
| |
Long-Term Disability Plan Certificate and Summary Plan Description (PDF) |
|
|
| |
Qualified Transportation Expenses (QTE) Plan (EBPA) |
| |
Enrollment/Change Form (PDF) |
|
Direct Deposit Form (PDF) |
| |
Reimbursement Claim Form (PDF) |
|
Plan Summary (PDF) |
| |
Retirement - Tax-Deferred Annuity (TDA) Plan (TIAA-CREF) |
| |
Salary Reduction Agreement Form (PDF) |
|
|
| |
Tuition Waver Application |
| |
(PDF) |
|
Tuition Waiver Application for Part-Time Faculty - Fall 2013 Semester (PDF) |
