Benefit

Category: Benefit
Form Number Title/Detailssort descending Department Direct Link
2016 Monthly Premiums for Health Human Resources and Academic Personnel Services PDF icon 2016_calpers_health_benefit_premiums_use.pdf

2016 Open Enrollment - Health Plan Change Only Form Human Resources and Academic Personnel Services PDF icon calpers_hbe_form_2016_oe_editable.pdf

2016 Open Enrollment Benefits Communication Human Resources and Academic Personnel Services PDF icon open-enrollment-cummunication_2016.pdf

2016 Open Enrollment Notice to Campus Human Resources and Academic Personnel Services PDF icon oe_for_2016_notice_to_campus.pdf

2017 CalPERS Health Benefit Premiums Human Resources and Academic Personnel Services PDF icon 2017_calpers_health_benefit_premiums.pdf

Authorization to Transport Form Human Resources and Academic Personnel Services PDF icon authorization_to_transport_form.pdf

Benefit Enrollment Worksheet PDF icon benefits_worksheet_with_calpers.pdf

Benefits Fair Flyer Human Resources and Academic Personnel Services PDF icon oe_and_benefit_fair_flyer2.pdf

Biometric Screening Quick Guide PDF icon maximwellness_registration_calpers_2014_2.pdf

CAL-ORE Life Flight Membership Form Human Resources and Academic Personnel Services PDF icon cal-ore_signup.pdf

CalPERS Beneficiary Designation Form

http://www.humboldt.edu/hsuhr/docs/benedesignee.pdf

CalPERS Health Plan Benefit Comparison Human Resources and Academic Personnel Services PDF icon calpers_health_plan_benefit_comparison_1_sheet_0.pdf

CalPERS Member Reciprocal Self-Certification Form

https://www.calpers.ca.gov/docs/forms-publications/self-certification.pdf

Career Development Plan

https://apex.humboldt.edu/ords/f?p=244:3

COBRA Rates for 2015 Microsoft Office document icon cobra_rates_for_2015.doc

CSU Fee Waiver Program Information

http://www.humboldt.edu/hsuhr/employee/waiver/index.html

DCRA-HRCA Enrollment Form Human Resources and Academic Personnel Services PDF icon dcra-hcra-2018-enrollment-form.pdf

Defense of Marriage Act Updates PDF icon defense_of_marriage_act_0.pdf

Dental Plan Enrollment Authorization PDF icon csu_dental_form.pdf

Direct Deposit for Employee Reimbursements Financial Services PDF icon direct_deposit_for_reimbursement_0.pdf

Domestic Partner Forms PDF icon formsdomesticpartnerbenefits_0.pdf

Domestic Partner Information PDF icon taxationofdomesticpartnershipbenefits-after11-08_0.pdf

e-Benefits Self-Service Electronic Signature Authorization Form Human Resources and Academic Personnel Services PDF icon e-benefits_electronic_sig_auth_form.pdf

Employee Assistance Program (EAP) PDF icon eap_0.pdf

Employee's Claim Form For Worker's Compensation Benefits PDF icon ecf_0.pdf

Fee Waiver Application-Dependent Human Resources and Academic Personnel Services

https://apex.humboldt.edu/ords/f?p=245:10

Fee Waiver Application-Self Human Resources and Academic Personnel Services

https://apex.humboldt.edu/ords/f?p=245:11

Flex Cash Enrollment Authorization Form PDF icon flexcash_enroll.pdf

HCRA/DCRA 2016 Open Enrollment Form Human Resources and Academic Personnel Services PDF icon drca_hcra_oe_form.pdf

Health Care/Dependent/Care Reimbursement Account Claim Form PDF icon claim_form.pdf

Highlights of New Voluntary Plans PDF icon pages_from_tl-ben2011-02.pdf

How Service Credit is Earned PDF icon service_credit_breakdown.pdf

Letter/Options for Sanders Voluntary Insurances PDF icon final_letter_to_covered_employees.pdf

PERS Declaration of Health Benefits PDF icon pers_declaration_of_health_hbd12a.pdf

Pre-Designation of Physician Human Resources and Academic Personnel Services PDF icon noticetoemployeespre-des.pdf

Pregnancy Disability Certification PDF icon pregnancy_disability_certification.pdf

Privacy Notice - Employee Assistance Program PDF icon october_2014_eap_notice.pdf

Quick Guide to Logging Your Steps PDF icon quick_guide_to_logging_your_steps.pdf

Request for Service Credit - Service Prior to Membership PDF icon request_for_service_credit_cost_information-_service_prior_to_membership.pdf

Retirement Information PDF icon retirement.pdf

Saving Made Easy - 403(b) Information PDF icon saving_made_easy_brochure_2014.pdf

Savings Plus Benefits Payment Booklet Human Resources and Academic Personnel Services PDF icon savingsplus_benefitpaymentbooklet.pdf

Self Service Guide: My Benefit Enrollments Human Resources and Academic Personnel Services PDF icon self-service_guide.pdf

Social Security & Your Retirement PDF icon seminarhsu.pdf

SPF Investment Comparitive Chart Sponsored Programs Foundation PDF icon 386686_investment_comparative_chart.pdf

SPF Out of Area WC Procedures Sponsored Programs Foundation PDF icon spf_out-of-area_w-c.pdf

SPF TIAA-Cref Summary of Plan Services and Costs Sponsored Programs Foundation PDF icon plan_related_info.pdf

SPF Workers' Comp Guide Sponsored Programs Foundation PDF icon spf-wc_process_for_supv_rev_03-13.pdf

Supervisor's Report of Injury Human Resources and Academic Personnel Services PDF icon supervisors_report.pdf

TSA Information Human Resources and Academic Personnel Services PDF icon saving_made_easy_brochure_2016_final.pdf

Universal Availability Notice - 403(b) Plan Information PDF icon universal_availability_notice-_final_20121218.pdf

Universal Availability Notice 2014 PDF icon universal_availability_notice_-2014_plan_year.pdf

VSP Out-of-Network Reimbursement Form PDF icon vsp_out-of-network_reimbursement_form.pdf

VSP Video Display Terminal (VDT) Claim Form PDF icon vsp_video_display_terminal_claim_form.pdf

VSP Vision Insurance Claim - No form required for vision services

W-4 W-4 - Employee's Witholding Allowance Certificate

http://www.irs.gov/pub/irs-pdf/fw4.pdf

Work-Related Injury Reporting Procedure PDF icon work_related_injury_reporting_procedures.pdf

Workers Compensation Pre-Designation of Physician Form Microsoft Office document icon noticetonewemployeeswebsiteonly.doc

Workers' Comp Quick Guide Human Resources and Academic Personnel Services PDF icon wcprocessforsupvrev04-15.pdf