GUIDELINES,
PROCEDURES AND POLICIES |
|
FORMS |
| FORM
NAME |
FORMAT |
PURPOSE
OF FORM |
State Health Benefits |
| Health
Benefits Program Application Form (Full-Time) |
PDF |
To
enroll in health benefits or update information. |
| Health Benefits Program Application Form (Part-Time) |
PDF |
To enroll in health benefits or update information. |
| High Deductible Health Plans for (Full-Time) |
PDF |
To
enroll in health benefits for full-time
staff. |
| High Deductible Health Plans for (Part-Time) |
PDF |
To
enroll in health benefits for full-time
staff. |
| HDHP Health Savings Account (HSA) form for (Full-Time) |
PDF |
To enroll in health savings account for tull-time staff. |
Health Benefits Program
Application Form (Retiree) |
PDF |
To enroll in health benefits or update information if you are a retiree |
| Dependent eligibility documents |
PDF |
Required documents for SHBP/SEHBP dependent eligibilty and enrollment |
| Application for Chapter 375 Coverage - Dependents to age 31 |
PDF |
To apply for coverage of a child up to age 31 |
| Dental Plan Application (Full-Time) |
PDF |
To enroll in dental benefits or update information |
| Waiver/Reinstatement Form |
PDF |
To waive or reinstate enrollment in SHBP |
| Affidavit of Dependency Form |
PDF |
To determine eligibility of dependent child/children |
Claim Forms |
| NJ Direct
Claim Form |
PDF |
To
file a NJ Direct claim for out of network health care benefits |
| Express Scripts/Medco Claim Form |
PDF |
To file a claim for reimbursement for prescriptions |
| Mail Order Express Scripts/Medco Claim Form |
PDF |
To file a claim for reimbursement for mail order prescriptions |
| Dental Expense Plan Claim Form |
PDF |
To file an Aetna claim for dental benefits |
TaxSave/Flexible Spending Accounts |
| Medical and Dental Expenses-IRS publication 502 |
PDF |
IRS guidance on flexible spending/unreimbursed medical accounts |
| Child and Dependent Care expenses - IRS publication 502 |
PDF |
IRS guidance on dependent care accounts |
| WageWorks Enrollment Form |
PDF |
To enroll in tax-free medical or dependent care program |
Public Employees' Retirement System (PERS) |
| Retirement Application - Instruction and Form |
PDF |
PERS retirement application |
| Disability Retirement Application |
PDF |
To apply for disability retirement under PERS |
| Request
for Retirement Estimate |
PDF |
To obtain a retirement fund estimate for members of PERS and TPAF
retirment funds |
| Adjunct/Part-time Instructors
ABP Election of Retirement Coverage Form |
PDF |
To
request a transfer of pension contributions to ABP or remain in PERS |
| ACTS
Salary Reduction Agreement |
PDF |
To
authorize a percentage reduction in an employee's salary to make additional
voluntary contributions on a tax-deferred basis beyond those required
by the mandatory membership in any state-administered retirement system. |
Alternate Benefit Program |
| ABP Common Questions and answers |
PDF |
Alternate Benefit Program frequently asked questions |
| ABP Member Handbook |
PDF |
NJ State Alternate Benefit Program Member Handbook |
| ABP Investment Carrier Comparison Guide |
PDF |
An information guide with points to consider in choosing from six carriers |
| ABP Enrollment Application |
PDF |
Active employee application for ABP enrollment |
| ABP Carrier Election Form |
PDF |
To file choice of carrier under ABP |
| ABP Retirement Application |
PDF |
To apply for retirement under ABP |
| Pension
withdrawal form |
PDF |
The
pension withdrawal form is needed for those who wish to consolidate
TPAF or PERS funds with an ABP account |
| Beneficiary Designation |
PDF |
To nominate a beneficiary for receipt of relevant benefits upon death of the member |
| ABP Long Term Disability Application |
PDF |
To apply for long term disability under ABP |
| Choosing between PERS and ABP |
PDF |
To assist newly eligible employees currently in PERS, TPAF, or PFRS in determining whether the PERS or the ABP system is better for them. |
| Election of Coverage Form for Adjuncts and Part Time Instructors |
PDF |
Within 30 days of commencing employment, Adjuncts and Part-Time Instructors with existing PERS membership must complete an Election of Coverage Form. |
| Salary Reduction Agreement - Supplemental Savings Plan |
PDF |
To authorize salary deductions for the supplemental 403b plan |
Deferred Compenstation Plan for enrollment or investment option information: |
| |
| Beneficiary Request Form |
PDF |
To designate a beneficiary |
Leaves of Absence |
| Family Medical Leave Procedures FMLA and FLA |
LINK |
Federal and State Family medical leave information |
| Personal Leave |
PDF
PDF |
Information & application for personal leave |
| Flex-Time Request Form |
PDF |
Information and Request for Flex-time Work Schedule |
| Extended Sick Leave |
PDF |
Information & application for extended leave |
Donated Leave Program for Classified Employees and Unclassified Professional Staff and Librarians
|
| Donated Leave |
PDF |
Donated Leave Program |
