General Contact Information

Office of Human Resources

Benefits

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• Summary of Benefits
• How to Enroll in a Tax Deferred Annuity (TDA)
• Tax Deferred Annuity (TDA) Change Forms
• Medical/Dental/Optical/FMLA Forms
• Health Insurance/Buy Out Waiver/Flexible Spending Account Information
• Tuition Waiver Information
• WageWorks Transit Program
• Important Phone Numbers
• Benefit Information and Forms
  • Classified Staff Benefit Information and Forms
  • Instructional Staff - Teaching, Non-Teaching( Faculty, HEO's,Registrar,CLT's), Classified Managerial and Executive Compensation Plan Benefits, Information and Forms
  • Part Time Instructional - Teaching and Non-Teaching Adjuncts
• Worker's Compensation
• Reporting Injuries
• CUNY e-Mall- Discounts for Faculty and Staff

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Summary of Benefits

• Full Time Teaching and Non-Teaching Instructional Staff Benefits Booklet
• Executive Compensation Plan (ECP) Benefits Booklet
• Summary for Full Time Faculty Members
• Summary for Higher Education Officers Series (HEO)
• Summary for Executive Compensation Plan (ECP) Members
• Summary for Full Time Classified Staff
• Summary for Adjunct Staff Members
• Summary for College Assistants and Tutors

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How to Enroll in a Tax Deferred Annuity (TDA)

Full and Part Time Instructional Staff -Faculty, HEO's, Registrar, CLT's, Continuing Education Teachers and Adjuncts

• TIAA-CREF 800-842-2766. Please submit proof of online enrollment along with 2012 Universal Form below to Human Resources
• HRC - Please contact James Werner - 1-800-786-1598
• Teachers Retirement System (TRS)-available to TRS members- Please call 1-888-8-NYC-TRS
• Halliday Financial Complimentary Consultation Memo

Classified Staff

• Metlife - Please contact Marc Adamek:917-701-6315

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Tax Deferred Annuity (TDA) Percentage Change Forms

For changes only-return completed forms to Human Resources.

     2013 Universal Tax Deferred Annuity Change Form-for HRC, MetLife and TIAA-CREF

• TIAA-CREF- Full and Part Time Instructional Staff-Faculty, HEOs, Registrar, CLT's, Continuing Education Teachers and Adjuncts
• HRC- Full and Part Time Instructional Faculty, HEOs, Registrar, CLT's, Continuing Education Teachers and Adjuncts
• MetLife- Full and Part Time Classified Staff
• Teachers Retirement System (TRS) TDA-available to TRS members- Please call 1-888-8-NYC-TRS

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Medical/Dental/Optical/Drug Claim/Hearing Aid/Wellness/FMLA Forms

• GHI Health Insurance Claim Form
  Return form to GHI

• Extended Medical Benefit - as of 7/1/08 - Please send the completed form, GHI Explanation of Benefits and itemized bill from Doctor to the address on the top of the form
• Guardian Dental Guard Preferred Benefit Information- for PSC CUNY emplyees only
• Guardian Dental Insurance - for PSC CUNY emplyees only PSC-CUNY Welfare Fund. For out of network providers. Please return the completed form to Guardian
• Delta Dental - for PSC CUNY emplyees only - as of 01/01/2007
• Delta Dental - Enrollment/Change form
• Claim Form for Direct Optical Reimbursement (PSC-CUNY Welfare Fund) Return form to PSC/CUNY Welfare Fund
• Drug Claims - Medco.  Members of Medco either use their Drug Card at a pharmacy or use Mail Order.  The most cost-effective way to buy long-term medications is to use Mail Order. Medco Mail Order Form If covered, but drugs were purchased, a Reimbursement Form is used. Medco Reimbursement Form
• Hearing Aid - Hearing Aid Reimbursement Form
• Wellness- Weight Watchers Reimbursement Form
• Family and Medical Leave Act (FMLA) Information
  • CUNY FMLA Leave Policy
  • CUNY FMLA Request Forms
    • CUNY Certification of Health Care Provider for Employees Serious Health Condition form
    • CUNY Certification of Health Care Provider for Family Members Serious Health Condition form
    • CUNY Certification of Qualifying Exigency for Military Family Leave form
    • CUNY Certification for Serious Injury or Illness of Covered Servicemember for Military Family Leave for
• PSC/CUNY Full Time Paid Parental Leave Form
• HEO Annual Leave Request Form- for use after paid parental leave is exhausted
• Application for the Childcare Leave - to be used for the unpaid portion of the leave by full time PSC-CUNY employees.
• Loss of Dependent Status COBRA Request Form

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Health Plans/Buy Out Waiver/ Flexible Spending Account Information

• Health Plan and Optional Rider Costs
• Health Insurance Information
• Health Benefits Enrollment Application
• Health Benefits Buy Out Waiver Application-2012
  Return with health benefits enrollment application,marriage/birth certificates and proof of non City health coverage
• Flexible Spending Account Information-2012
• Flexible Spending Account Enrollment Form-2012
• Young Adult Dependent Age 26 Health Insurance
• Health Care Flexible Spending Account (HCFSA) Program
  • Employees must re-enroll each year during open enrollment
  • Claim Form 2011
• Dependent Care Assistance Program (DeCAP)
  • Employees must re-enroll each year during open enrollment
  • Claim Form 2011

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Tuition Waivers

• Baruch College Tuition Waiver Forms and Information

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Important Phone Numbers

• Classified Staff Contact Sheet
• Full and Part Time Teaching and Non Teaching Instructional Staff (Faculty, HEO's, Registrar , CLT's and Adjuncts) Contact Sheet

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Benefit Information and Forms

Full and Part Time Classified Staff

• Full Time Employee DC 37 Health and Security Plan Benefits (Click on Benefit Link)
• Health Plan and Optional Rider Costs
• Health Insurance Information
• Health Benefits Enrollment Application
• Health Benefits Buy Out Waiver Application-2012
  Return with health benefits enrollment application,marriage/birth certificates and proof of non City health coverage

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Full Time Instructional Staff - Teaching and Non-Teaching, Classified Managerial and Executive Compensation Plan

• PSC/CUNY Welfare Fund Data Sheet-to sign up for Welfare Fund benefits and add dependents. (This form is available in Human Resources)
• Health Plan and Optional Rider Costs
• Health Insurance Information
• Health Benefits Enrollment Application
• Health Benefits Buy Out Waiver Application-2012
  Return with health benefits enrollment application,marriage/birth certificates and proof of non City health coverage
• Guardian Dental Schedule of Allowable charges
• Guardian Dental Guard Preferred Benefit Information
• Guardian Dental Insurance - PSC-CUNY Welfare Fund. For out of network providers. Use Group Number G381084. Return form to Guardian
• Delta Dental
• Delta Dental - Enrollment/Change form
• Claim Form for Direct Optical Reimbursement (PSC-CUNY Welfare Fund)
• Drug Claims - Medco.  Members of Medco either use their Drug Card at a pharmacy or use Mail Order.  The most cost-effective way to buy long-term medications is to use Mail Order. Medco Mail Order Form If covered, but drugs were purchased, a Reimbursement Form is used.Medco Reimbursement Form
• Hearing Aid - Hearing Aid Reimbursement Form
• Wellness- Weight Watchers Reimbursement Form
• Optical Provider Listing-General Vision Services
• Optical Provider Listing-Davis Vision

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Part Time Instructional - Teaching and Non-Teaching Adjuncts

• Adjunct Request for Voice Mail

• CUNY Doctoral Student Health Insurance

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WageWorks Transit Program

• Information and Enrollment Forms
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Worker's Compensation

• Reporting Injuries and Accidents

• DP2002 Form
• Employee report
• Supervisor report
• Witness statement

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