Benefits

Beneficiary Forms

• CSEA Accidental Death (log in with your CSEA ID)
• UUP Life (pdf)
• MC Life (pdf)
• TIAA (pdf)
• Employee Retirement System (pdf)
• Police and Fire Retirement System (pdf)
• Teachers Retirement System (pdf)
• NYS Deferred Compensation

Family Medical Leave Act Forms

• Employee Info: FMLA Rights and Responsibilities Notice (pdf)
• Employee: FMLA Notice of Eligibility (pdf)
• Human Resources: FMLA Approval/Disapproval (pdf)
• Employee/Dr: Employee's Serious Illness (pdf)
• Employee/Dr: Family Member's Serious Illness (pdf)
• Employee: Military Family Leave (pdf)
• Employee: Military Family Member's Injury (pdf)

Health Insurance & Related Program Forms

• Empire Plan Claim (pdf)
• All Flex Spending Reimbursement Forms
• Health Insurance Enrollment/Changes (pdf) (PS 404)
• Domestic Partner Application for benefits (pdf)

Health: Dental & Vision Claim, Student Verification Forms

MC , APSU/PBA and NYSCOPBA

• GHI Dental Claim (pdf)
• Davis Vision Claim (pdf)
• Dental Student Verification (pdf)
• Vision Student Verification (pdf)

UUP

• Delta Dental Claim (pdf)
• Davis Vision Claim (pdf)
• Student Verification (pdf)

CSEA

• Look up your CSEA ID #/Order Replacement Card
• Dental Claim (pdf)
• Vision Claim (pdf)
• Student Verification (pdf)

Retirement Forms

• New York State Employees' Retirement System (ERS)
• New York State Teachers' Retirement System (TRS)
• TIAA-CREF

Tuition Benefit Program

• SUNY Tuition Assistance Application (pdf)
• SUNY Delhi UUP Waiver Registration (pdf)
• Employee Mandatory Fee Waiver Request

UUP Individual Development Awards

• Supplemental Information Form (pdf)