Forms & Brochures

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

A

Back to Top

B

• Benefits Overviews
• CSU Benefits Website
• Benefits Worksheet (Not for Open Enrollment)
• Bereavement Leave
• Blue Shield
  • Blue Shield Advantage - Evidence of Coverage
  • Blue Shield Net Value Advantage - Evidence of Coverage
  • Physician Selection Form

Back to Top

C

• CalPERS
  • Benefit Table
  • Completing the Disability Retirement Election Application
  • Completing the Service Retirement Application
  • Disabled Dependent Benefit Medical Report (HBD-34)
  • Disabled Dependent Benefit Member Questionnaire (HBD-98)
  • Disability Retirement Election Application
  • Planning Your Service Retirement
  • Refund-Rollover Election Information
  • Refund Tax Information
  • Service Credit Purchase Options
  • Service Retirement Election Application
  • State Member Benefits
  • When You Change Retirement Systems
• Catastrophic Leave Donation Program (CLDP)
  • Donation Chart
  • Summary
  • Option Sheet
• COBRA
  • Continuation Election Form
  • Description
  • Rates
• Collective Bargaining Agreements
  • Faculty
  • Staff
• Credit Unions

Back to Top

D

• Declaration of Health Coverage (HBD-12A)
• Delta Dental
  • Claim Form
  • Plan Summary
• Dental Group Numbers
• 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
• Domestic Partnership
• Certification
• Domestic Partnership Taxable Income for Benefits

Back to Top

E

Back to Top

F

• FlexCash
  • FlexCash and TAPP Brochure
  • FlexCash Enrollment Form
• Flexible Spending Plans
  • HCRA and DCRA Enrollment Form (Not for Open Enrollment)
  • 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 -CalPERS
• CalPERS Open Enrollment News
• Health Rates 2014
• Health Rates 2015
• Health Chooser
• Health Plans Online
• Health Plan by Zip Code
• Health Plan Summary 2015
• Health Program Guide 2015
• Parent- Child Relationship
• 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 Absence Request
• Request for Non-Medical Leave - Staff & MPP
• Medical Leave Application
• Disability
  • NDI - How to file a claim
  • NDI - Provisions
  • Pregnancy - Notice B
  • Pregnancy -Certification of Health Care Provider
• Family and Medical Leave (FMLA)
• Certification of Health Care Provider for Employee
• Certification of Health Care Provider for Family Member
• Certification of Health Care Provider for Paternity Leave
• Notice and Request Form
• Employee Rights and Responsibilities
• Life Insurance
  • Brochure
  • Certificate
  • Eligible Employee
• Long-Term Care Brochures
• Long Term Disability Insurance (LTD)
  • Brochure
  • Certificate
  • Eligible Employee
  • Reasonable Accommodation Expense Benefit
  • Return to Work Incentive/Child Care Expense Benefit
  • Right to Convert
  • Survivors Benefit

Back to Top

M

• Maternity / Paternity / Adoption / Parental Leave
  • Chart
  • Website

Back to Top

N

• Nonindustrial Disability (NDI)
  • Rate Chart
  • Summary
  • Provisions
• Non-Medical Leave of Absence for Staff and MPP
• Non-Participating Tax Advantage Premium Plan (TAPP) form

Back to Top

O

• Back to Top

P

• Part-Time Faculty Benefits Eligibility
• Part-time, Seasonal and Temporary Employees Retirement Program (PST)
  • Fact Sheet
  • PST Benefit Payment Booklet
• 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) )
  
  • Comparison Chart 2015
  • Maximum Catch-up Worksheet 2014
  • Savings Made Easy Brochure 2015
  • Universal Availability Notice 2015
  • 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