|
2016 Monthly Premiums for Health |
Human Resources |
2016_calpers_health_benefit_premiums_use.pdf |
|
2016 Open Enrollment - Health Plan Change Only Form |
Human Resources |
calpers_hbe_form_2016_oe_editable.pdf |
|
2016 Open Enrollment Benefits Communication |
Human Resources |
open-enrollment-cummunication_2016.pdf |
|
2016 Open Enrollment Notice to Campus |
Human Resources |
oe_for_2016_notice_to_campus.pdf |
|
2017 CalPERS Health Benefit Premiums |
Human Resources |
2017_calpers_health_benefit_premiums.pdf |
|
Authorization to Transport Form |
Human Resources |
authorization_to_transport_form_2024.pdf |
|
Benefit Enrollment Worksheet |
|
benefits_enrollment_worksheet_052024_final.pdf |
|
Benefits Fair Flyer |
Human Resources |
oe_and_benefit_fair_flyer2.pdf |
|
Biometric Screening Quick Guide |
|
maximwellness_registration_calpers_2014_2.pdf |
|
CAL-ORE Life Flight Membership Form |
Human Resources |
cal_ore_application_2024.pdf |
|
CalPERS Beneficiary Designation Form |
|
http://www.humboldt.edu/hsuhr/docs/benedesignee.pdf |
|
CalPERS Health Plan Benefit Comparison |
Human Resources |
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 |
|
cobra_rates_for_2015.doc |
|
CSU 403(b) form |
Human Resources |
csu_403b_srp_enrollment_form_new_number.pdf |
|
CSU Fee Waiver Program Information |
|
http://www.humboldt.edu/hsuhr/employee/waiver/index.html |
|
Defense of Marriage Act Updates |
|
defense_of_marriage_act_0.pdf |
|
Dental Plan Enrollment Authorization |
|
csu_dental_form.pdf |
|
Direct Deposit for Accounts Payable Reimbursements |
Financial Services |
https://link.humboldt.edu/ZG6 |
|
Domestic Partner Forms |
|
formsdomesticpartnerbenefits_0.pdf |
|
Domestic Partner Information |
|
taxationofdomesticpartnershipbenefits-after11-08_0.pdf |
|
e-Benefits Self-Service Electronic Signature Authorization Form |
Human Resources |
e-benefits_electronic_sig_auth_form.pdf |
|
Employee Assistance Program (EAP) |
|
eap_0.pdf |
|
Employee's Claim Form For Worker's Compensation Benefits |
|
dwc_1.pdf |
|
Fee Waiver Application-Dependent |
Human Resources |
https://apex.humboldt.edu/ords/f?p=245:10 |
|
Fee Waiver Application-Self |
Human Resources |
https://apex.humboldt.edu/ords/f?p=245:11 |
|
Health Care/Dependent/Care Reimbursement Account Claim Form |
|
claim_form.pdf |
|
Highlights of New Voluntary Plans |
|
pages_from_tl-ben2011-02.pdf |
|
How Service Credit is Earned |
|
service_credit_breakdown.pdf |
|
Letter/Options for Sanders Voluntary Insurances |
|
final_letter_to_covered_employees.pdf |
|
PERS Declaration of Health Benefits |
|
pers_declaration_of_health_hbd12a.pdf |
|
Pre-Designation of Physician |
Human Resources |
noticetoemployeespre-des.pdf |
|
Pregnancy Disability Certification |
|
pregnancy_disability_certification.pdf |
|
Privacy Notice - Employee Assistance Program |
|
october_2014_eap_notice.pdf |
|
Quick Guide to Logging Your Steps |
|
quick_guide_to_logging_your_steps.pdf |
|
Request for Service Credit - Service Prior to Membership |
|
request_for_service_credit_cost_information-_service_prior_to_membership.pdf |
|
Retirement Information |
|
retirement.pdf |
|
Saving Made Easy - 403(b) Information |
|
saving_made_easy_brochure_2014.pdf |
|
Savings Plus Benefits Payment Booklet |
Human Resources |
https://nationwidefinancial.com/media/pdf/NRM-4204CA.pdf?_ga=2.218510169.1738... |
|
Self Service Guide: My Benefit Enrollments |
Human Resources |
self-service_guide.pdf |
|
Social Security & Your Retirement |
|
seminarhsu.pdf |
|
SPF Out of Area WC Procedures |
Sponsored Programs Foundation |
spf_out-of-area_w-c.pdf |
|
SPF TIAA-Cref Summary of Plan Services and Costs |
Sponsored Programs Foundation |
plan_related_info.pdf |
|
SPF Workers' Comp Guide |
Sponsored Programs Foundation |
spf-wc_process_for_supv_rev_03-13.pdf |
|
Supervisor's Report of Injury |
Human Resources |
supervisors_report.pdf |
|
TSA Information |
Human Resources |
saving_made_easy_brochure_2016_final.pdf |
|
Universal Availability Notice - 403(b) Plan Information |
|
universal_availability_notice-_final_20121218.pdf |
|
Universal Availability Notice 2014 |
|
universal_availability_notice_-2014_plan_year.pdf |
|
VSP Out-of-Network Reimbursement Form |
|
vsp_out_of_network_reimbursement_form-2.pdf |
|
VSP Video Display Terminal (VDT) Claim Form |
|
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 |
|
work_related_injury_reporting_procedures_2024.pdf |
|
Workers Compensation Pre-Designation of Physician Form |
|
noticetonewemployeeswebsiteonly.doc |
|
Workers' Comp Quick Guide |
Human Resources |
wcprocessforsupvrev04-15.pdf |