Forms & Brochures

ABCDEFGHIJKLMNOPQRSTUVWXYZ

A

Back to Top

B

• Benefits
• Benefits Overviews
• CSU Benefits Website
• Forms
• Benefits Worksheet (New Hire)
• Benefits Worksheet (Family Status Change)
• Affidavit of Parent-Child Relationship (HBD-40)
• Affidavit of Marriage/Domestic Partnership
• Disabled Dependent Benefit Medical Report (HBD-34)
• Disabled Dependent Benefit Member Questionnaire (HBD-98)
• Non-Participating Tax Advantage Premium Plan (TAPP) form
• CalPERS - Health
  • Health Rates 2016
  • Health Chooser
  • Health Plan Summary 2016
  • Health Program Guide 2016
• FlexCash
  • FlexCash Brochure
  • FlexCash Enrollment Form
• Blue Shield
• Blue Shield Advantage - Evidence of Coverage
• Blue Shield Net Value Advantage - Evidence of Coverage
• Physician Selection Form

Back to Top

C

• CalPERS - Retirement
  • State Miscellaneous Benefits (Staff/Faculty/MPP)
  • State Safety Benefits (Police Officer)
  • Planning Your Service Retirement
  • Employment After Retirement
  • Reinstatement from Retirement
  • Service Credit Purchase Options
  • Special Power of Attorney
  • When You Change Retirement Systems
  • Application
    • Service Retirement Election Application
    • Disability Retirement Election Application
  • Separation
    • Refund-Rollover Election Information
    • Refund Tax Information
• COBRA
  • Continuation Election Form
  • Description
  • Rates
• Credit Unions

Back to Top

D

• Delta Dental Plans (PPO & HMO)
• Dental Group Numbers
• Evidence of Coverage
  • Delta Dental PPO
  • Delta Care HMO - Basic
  • Delta Care USA HMO - Enhanced
• Dental Summaries
  • Units 1, 2,3, 4, 5, 6, 7, 9, C99, M98, M80, and FERP Annuitants
  • Unit 10, and Teaching Associates
  • Units 8, E99, and Annuitants (retirees)
• Domestic Partnership
  • Certification
  • Domestic Partnership Taxable Income for Benefits

Back to Top

E

Back to Top

F

• Flexible Spending Plans
  • HCRA and DCRA Enrollment Form
  • HCRA and DCRA Claim Form
• Dependent Care Reimbursement Account (DCRA)
  • DCRA Brochure
• Health Care Reimbursement Account (HCRA)
  • HCRA Brochure
  • HCRA Debit Card Form
  • HCRA Debit Card FAQ

Back to Top

H

• Health Insurance Portability and Accountability Act (HIPAA)
  • HIPAA Authorization to Use and/or Disclose Personal Health Plan Information
  • HIPAA Privacy Policy 2004
  • HIPAA Privacy Notice 2012

Back to Top

K

• Kaiser
  • Evidence of Coverage

Back to Top

L

• Leave of Absences
  • Non-Medical Leave - Staff & MPP
  • Medical Leave Application - Faculty, Staff & MPP
  • Family and Medical Leave (FMLA)
    • FML Rights and Responsibilities
    • Notice and Request Form
    • Employee - Certification of Healthcare Provider
    • Family Member- Certification of Healthcare Provider
    • Paternity Leave - Certificate
• Catastrophic Leave Donation Program (CLDP)
  • Donation Chart
  • Summary
  • Option Sheet
• Nonindustrial Disability Insurance (NDI)
• • NDI - How to file a claim
  • NDI Rate Chart
  • NDI Summary
  • NDI - Provisions
• Pregnancy Disability
  • Pregnancy - Notice B
  • Pregnancy -Certification of Health Care Provider
• Life Insurance (Employer-Paid)
  • Brochure
  • Certificate
  • Eligible Employee
• Long-Term Care CalPERS
• Long Term Disability Insurance (LTD)
  • Brochure
  • Certificate

Back to Top

M

Back to Top

N

Back to Top

O

• Open Enrollment
  • Health Plan Rates 2016
  • Health Plan Summary 2016
  • Health Program Guide 2016
  • CSU Open Enrollment Newsletter
  • CalPERS Open Enrollment News
  • DCRA/HCRA 2016 Enrollment Form

Back to Top

P

• Part-Time Faculty
  • Benefits Eligibility
• Part-time, Seasonal and Temporary Employees Retirement Program (PST)
  • Fact Sheet
• PERS Choice/PERS Care/PERS Select
  • Member Claim Form
  • PERS Care - Evidence Coverage
  • PERS Choice - Evidence of Coverage
  • PERS Select - Evidence of Coverage
• Pre-Tax Parking Deduction Plan
  • Brochure
  • Cancellation Form
• Pre- Tax Savings Plans (403 (B) )
• CSU Pre-Tax Comparison Chart
• TSA - Savings Made Easy
• Universal Availability Notice
• 403 (b) Withdrawals, Loans & Rollovers

Back to Top

S

Back to Top

T

• Tax Advantage Premium Plan (TAPP)
  • Brochure
  • Non-Participating Tax Advantage Premium Plan (TAPP) Form

Back to Top

V

• Vision Service Plan (VSP) Benefits
  • Benefits Summary
  • Participating Provider Network
  • Reimbursement Form (Out-of-network)
  • VDT Claim Form

Back to Top