Contents
HRS
Customer Svc.
Diversity
Human Resources
ODT
Payroll
Risk Mgt.
Benefits
Forms
& Publications
Benefits Enrollment
Benefits Enrollment Worksheet (
PDF
or
Word
)
Declaration of Health Coverage
(.pdf)
CalPERS Disabled Dependent Benefit form (HBD-98)
Medical Report for the CalPERS Disabled Dependent Benefit form (HBD-34)
Economically Dependent Child - Affidavit of Eligibility Form
Benefits Summaries by Bargaining Unit
Physicians (Unit 1)
CSUEU Support Services (Units 2,5,7, and 9)
Faculty (Unit 3)
Academic Support (Unit 4)
Skilled Craft (Unit 6)
Public Safety (Unit 8)
Teaching Associates (Unit 11)
Management Personnel Plan (MPP)
Confidentials (C99)
Dental
Delta Dental PPO- Evidence of Coverage Brochure
DeltaCare USA- Evidence of Coverage Brochure Basic Plan
DeltaCare USA- Evidence of Coverage Brochure Enhance Plan
DeltaCare USA- Description of Benefits/Co-payments
FlexCash
Flex Cash Brochure
Flexible Spending Accounts
Dependent Care Reimbursement Account (DCRA)
DCRA Enrollment Form
DCRA and HCRA combined brochure
DCRA Brochure
DCRA Claim Form
Health Care Reimbursement Account (HCRA)
HCRA Enrollment Form
DCRA and HCRA combined brochure
HCRA Brochure
HCRA Claim Form
Life Insurance
Employer Paid Group Life Insurance- Standard Life Beneficiary Form
Employer Paid Group Life Insurance- Standard Life Insurance Certificate
Long-Term Disability
Standard LTD Certificate
Pre-Tax Parking
Pre- Tax Parking Brochure
Retirement
State Member Benefits (
State Misc
&
State Safety
)
Requesting an Estimate
Service Credit Purchase
Service Retirement Election Application
Applying for Disability Retirement
Life Events - What You Need to Know
CalPERS Videos
Community Property Issues
Leaving CalPERS Membership
Power of Attorney
(CalPERS Form & Publication)
CalPERS Beneficiary Designation Form (CalPERS-BSD-241)
Working and Benefits after Retirement
Tax Sheltered Annuities (TSA) 403(b)
Salary Reduction Agreement
(SRA)
Maximum Contribution Worksheet 2008 (
PDF
or
Word
)
Maximum Contribution Worksheet 2008 (
Auto Calculation
)
TSA Limit for 2008
Authorized 403(b) TSA Companies
Vision
Vision Brochure (Certificate of Coverage)
Vision Claim Form - Not required when using standard in-network benefits (see
Vision Benefits
for details).
Vision - VSP Out-of-Network Reimbursement Form (.pdf)
Vision - VDT Claim Form
Vision- Locating a provider
