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. Sign-in to the HRConnect Employee Service Center .
2. Choose Request Assistance/Benefits/Tuition Waiver Request.
3. Complete the tuition waiver form within HRConnect.
Tuition Waiver questions may be submitted using the Tuition Waiver Inquiry request.
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
- Visit Empower Retirement's website to access current forms.