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Forms - Benefits

DepartmentTitle/DetailsForm NumberDirect Link
HR2016 Monthly Premiums for Health
HR2016 Open Enrollment - Health Plan Change Only Form
HR2016 Open Enrollment Benefits Communication
HR2016 Open Enrollment Notice to Campus
Document
HR2017 CalPERS Health Benefit Premiums
HRAuthorization to Transport Form
HRBenefit Enrollment Worksheet
HRBenefits Fair Flyer
Document
HRBiometric Screening Quick Guide
HRCAL-ORE Life Flight Membership Form
Document
HRCalPERS Beneficiary Designation Formhttp://www.humboldt.edu/hsuhr/docs/benedesignee.pdf
HRCalPERS Health Plan Benefit Comparison
HRCalPERS Member Reciprocal Self-Certification Formhttps://www.calpers.ca.gov/docs/forms-publications/self-certification.pdf
HRCareer Development Planhttps://apex.humboldt.edu/ords/f?p=244%3A3
HRCOBRA Rates for 2015
Document
HRCSU 403(b) form
HRCSU Fee Waiver Program Information https://www.humboldt.edu/hr/employee-benefits/fee-waiver
HRDefense of Marriage Act Updates
Document
HRDental Plan Enrollment Authorization
Document
csudentalform.pdf (849.86 KB)
Financial ServicesDirect Deposit for Accounts Payable Reimbursementshttps://link.humboldt.edu/ZG6
HRDomestic Partner Forms
HRDomestic Partner Information
HRe-Benefits Self-Service Electronic Signature Authorization Form
HREmployee Assistance Program (EAP)
Document
eap0.pdf (518.35 KB)
HREmployee's Claim Form For Worker's Compensation Benefits
Document
dwc1.pdf (103.25 KB)
HRFee Waiver Application-Dependenthttps://apex.humboldt.edu/ords/f?p=245%3A10
HRFee Waiver Application-Selfhttps://apex.humboldt.edu/ords/f?p=245%3A11
HRHealth Care/Dependent/Care Reimbursement Account Claim Form
Document
claimform.pdf (518.28 KB)
HRHighlights of New Voluntary Plans
Document
HRHow Service Credit is Earned
Document
HRLetter/Options for Sanders Voluntary Insurances
HRPERS Declaration of Health Benefits
HRPre-Designation of Physician
Document
HRPregnancy Disability Certification
HRPrivacy Notice - Employee Assistance Program
Document
HRQuick Guide to Logging Your Steps
HRRequest for Service Credit - Service Prior to Membership
HRRetirement Information
Document
retirement.pdf (315.75 KB)
HRSaving Made Easy - 403(b) Information
Document
HRSavings Plus Benefits Payment Booklethttps://nationwidefinancial.com/media/pdf/NRM-4204CA.pdf?_ga=2.218510169.1738...
HRSelf Service Guide: My Benefit Enrollments
Document
HRSocial Security & Your Retirement
Document
seminarhsu.pdf (1.44 MB)
ResearchSPF Out of Area WC Procedures
Document
ResearchSPF TIAA-Cref Summary of Plan Services and Costs
Document
ResearchSPF Workers' Comp Guide
HRSupervisor's Report of Injury
Document
HRTSA Information
HRUniversal Availability Notice - 403(b) Plan Information
HRUniversal Availability Notice 2014
HRVSP Out-of-Network Reimbursement Form