Employee Benefits Forms

Employee Benefits Forms

http://www.passhe.edu/inside/HR/syshr/Pages/default.aspx

Below are links to some of our most requested benefits forms. If there is a form you need that is not listed here, contact the Office of Human Resources.

LONG-TERM DISABILITY INSURANCE FORMS

DEFERRED COMPENSATION PLAN FORMS

FLEXIBLE SPENDING ACCOUNT

HEALTH INSURANCE FORMS FOR FACULTY, MANAGERS, NURSES, COACHES AND POLICE OFFICERS

HEALTH INSURANCE FORMS FOR AFSCME AND SCUPA

GROUP LIFE INSURANCE FORMS

SERS FORMS

TAX-SHELTERED ANNUITY – RETIREMENT@WORK

TUITION WAIVER FORMS

A waiver of tuition to the State System universities is available to eligible employees and their dependents. Eligibility guidelines and specific benefit administration differs according to the employee’s collective bargaining agreement or non-represented status.
 
To apply for a tuition waiver, please follow the steps below.
 
1. Complete a tuition waiver request form available at: Tuition Waiver Form.
2. Sign-in to the HRConnect Employee Service Center.
3. Choose Request Assistance/Benefits/Tuition Waiver Inquiry/Request.
4. Complete the questions and add the completed form as an attachment.
 
Tuition Waiver questions may be submitted using the same inquiry type.

 

FACULTY HEALTH AND WELFARE FUND

  • Faculty Dental and Vision information may be found at PAFAC website.

LIFE AND ACCIDENT INSURANCE

EMPOWER RETIREMENT, THE RETIREMENT BUSINESS OF GREAT-WEST FINANCIALS