Human Resources Website

Benefits Forms

 

 Summary of Benefits Booklet

  New Employee Benefit Forms (Required)

  • Benefits Waiver Form
  • Retirement Election Agreement (If eligible)
  • Post Mortem Beneficiary
  • Staff Classified Employee Handbook Acknowledge Form 

    •  

     

      Healthcare

     Dental

  • Board of Regents Indemnity Dental Claim Form
  • MetLife Dental Claim Form
  • Domestic Partner Affidavit

    •  Vision

  • United Healthcare Vision Georgia Participating Provider Directory
  • Domestic Partner Affidavit

    •  Voluntary Term Life Insurance Plan

  • Domestic Partner Affidavit

    •  Disability

  • Evidence of Insurability
  • Cancellation Form
  • Claim Form
  • University Appeals and Complaints
  • Employee Voluntaray Disclosure of Disability
  • Employee Accommodation Request Form

    •  Mandatory Retirement

  • ORP Allocation
    • Account Applications:
  • Teachers Retirement System of GA Membership Application Form
  • American Century
  • Fidelity
  • TIAA-CREF

    TIAA-CREF: Steps to Enroll Online

    1.  Log in to www.tiaa-cref.org/georgiastateuniversity AND CLICK “ENROLL NOW”
    2.  Under “Enroll Online”, click on the link for the plans you want to enroll in.
    3.  Follow the on-screen directions to complete your enrollment application.  Once you complete your enrollment, you can retrieve and print a confirmation page from the “Congratulations” screen.
    4.  Note: You will need to complete a Salary Reduction Agreement form in order to process your enrollment application.  Click the link “Georgia State University Salary Reduction Agreement”, complete and submit to the Georgia State University Benefits Office.   

  • VALIC Retirement

    •  Voluntary Retirement - 403(b) and 457  

  • 2009 Salary Reduction Agreement (Required for New Enrollment, Change or Cancellation. Can be faxed directly to Corrin Sorteberg)

  • Salary Reduction Agreement for November 2009

  • Declaration of Normal Retirement Age

    Account Applications:

  • Fidelity:

    • TIAA-CREF: Steps to Enroll Online

    1.  Log in to www.tiaa-cref.org/georgiastateuniversity AND CLICK “ENROLL NOW”
    2.  Under “Enroll Online”, click on the link for the plans you want to enroll in.
    3.  Follow the on-screen directions to complete your enrollment application.  Once you complete your enrollment, you can retrieve and print a confirmation page from the “Congratulations” screen.
    4.  Note: You will need to complete a Salary Reduction Agreement form in order to process your enrollment application.  Click the link “Georgia State University Salary Reduction Agreement”, complete and submit to the Georgia State University Benefits Office 

     Flexible Spending Accounts

  • FSA Card Secondary Card Request Form
  • FSA Health Care Claim Form
  • FSA Dependent Care Claim Form 
  • Parking Claim Form 
  • Transit claim form
  • Marta Card Enrollment and Change Form

    •  Path2College 529 Plan

  • Path2College 529 Plan Payroll Deduction Form

    Click on the link to access the new site:
    http://www.path2college529.com/

    •  Tuition Assistance Program

  • TAP Application Form

    •  Family Medical Leave Act

  • Certification of Health Care Provider for Employee's Serious Health Condition (New)
  • Certification of Health Care Provider for Family Member's Serious Health Condition (New)
  • FMLA Policy  

    •  Donated Leave Program

  • Donated Leave Request Form
  • Donated Leave Physician Certificate
  • Donated Leave Donor Transfer Form

    •  American Disability Act (ADA)

  • Employee ADA Medical Certification
  • Essential Functions Analysis for Supervisors
  • Job Analysis for Supervisor

    •  

     

     

  •