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How Benefits Are Affected When Employment Terminates |
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Status of Your Benefits Upon Termination - Full-time Faculty and Staff (PDF) |
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2013 COBRA Rates (PDF) |
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Statement of Domestic Partnership |
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Statement of Domestic Partnership (PDF) |
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Dental Care Plans (Delta Dental) |
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PPO Plan Reimbursement Claim Form (PDF)
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DeltaCare (DHMO) Summary of Benefits (PDF) |
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Enrollment/Change Form - Full-Time Faculty and Administrative Staff (PDF) |
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Dental PPO Plan Summary (PDF) |
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Enrollment/Change Form - Part-Time Faculty (PDF)
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Flexible Spending Accounts (EBPA) |
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IRS Eligible Expenses (PDF) |
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Direct Deposit Form (PDF) |
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Over-The-Counter Items Eligible for Reimbursement |
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Dependent Care Expenses Cost Estimation Worksheet (PDF) |
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Dependent Care Claim Form (PDF) |
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Health Care Expenses Cost Estimation Worksheet (PDF) |
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Health Care Claim Form (PDF) |
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Additional Benefits Card Request Form (PDF) |
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Health Care Plan |
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Health Care Enrollment/Change Form for Full-Time Faculty and Administrative Staff (PDF) |
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Health Care Enrollment/Change Form for Part-Time Faculty (PDF) |
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Summary of Benefits and Coverage (SBC)- Choice Plus 500 (PDF) |
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Summary of Benefits and Coverage (SBC)-Choice Plus 1000 (PDF) |
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Summary of Benefits and Coverage (SBC)- Choice EPO (PDF) |
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Summary of Benefits and Coverage (SBC)- High Deductible Health Plan (PDF) |
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UnitedHealthcare Reimbursement Claim Form (PDF) |
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UnitedHealthcare Reimbursement Claim Form For Mental Health Services Only (PDF) |
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UnitedHealthcare's Health Discounts Program (PDF) |
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The New School Health Plan Notice of Privacy Practices—Self-Funded Plans (PDF) |
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UnitedHealthcare Vision Plan
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Prescription Drug Coverage
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Health Saving Account Application (PDF) (available only if enrolled in the High Deductible Health Plan) |
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Health Saving Account - Employee Contribution Form (PDF) (available only if enrolled in the High Deductible Health Plan) |
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Oxford Reimbursement Claim Form (PDF) (for 2012 medical and vision care expenses only - must be submitted within 180 days of date of service) |
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Life Insurance Plan (The Standard Life Insurance Company of NY) |
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Life Insurance Beneficiary Designation Form (PDF) |
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(PDF) |
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Long Term Care Information |
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Long Term Planning Associates, LLC (PDF) |
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Long-Term Disability Plan (The Standard Life Insurance Company of NY)
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Long-Term Disability Plan Certificate and Summary Plan Description (PDF) |
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Qualified Transportation Expenses (QTE) Plan (EBPA) |
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Enrollment/Change Form (PDF) |
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Direct Deposit Form (PDF) |
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Reimbursement Claim Form (PDF) |
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Plan Summary (PDF) |
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Retirement - Tax-Deferred Annuity (TDA) Plan (TIAA-CREF) |
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Salary Reduction Agreement Form (PDF) |
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Tuition Waver Application |
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(PDF) |
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Tuition Waiver Application for Part-Time Faculty - Summer 2013 Semester (PDF) |
