HEALTH INSURANCE CHANGES
NYSUT INFORMATION SHEET
CSEA INFORMATION SHEET
Sexual Harassment Prevention Training
Sexual Harassment Prevention Training Case Studies
EDLAW2D/Data Privacy Training
HUMAN RESOURCES FORMS AND LINKS
403(b) forms & links
CSEA Vision Care Forms
Employee forms (teacher timesheet, mileage, expense, direct deposit, leave req.)
Health Insurance Forms and Links
Federal/State Tax forms
Life Insurance Form
PGP Flex Spending Plan forms & link
Policies & Information (Medicaid, HIPAA, Workers Comp.)
403(b) forms & links
Smart Choice 403(b) www.cpcfs.com
Smart Choice Enrollment Booklet
Smart Choice Universal Availability Notice 2019
OMNI www.omni403b.com
403 (b) Retirement Plan Document
403 (b) Salary Reduction Agreement
OMNI 403(b) Why me?
403 (b) Contribution Percentage Change Form
OMNI - 2020 Universal Availability Notice
Tax Forms
IT-2104- NY State Tax - Employeea's Withholding Allowance Certificate
W-4 - Federal Tax - Employee's Withholding Allowance Certificate
I-9 - Employment Eligibility Verification
Employee forms
WinCapWEB Employee Self Service
WinCapWEB Leave Request Instructions
Home Teaching Timesheet
CSEA Timesheet
Teacher & Hourly Timesheet
Mileage Reimbursement Form
Employee Expense Claim Form
Direct Deposit (Adobe pdf fill-in form)
Notice of Employee Leave
Conference Request Form
STA Course Approval Form
Sick Bank Enrollment Form
PGP Flexible Spending Plan forms & link
PGP website www.thepreferredgroup.com
PGP Flexible Spending Plan Description
PGP Flexible Spending Plan Summary
PGP Eligible and Ineligible Expenses
PGP Blank Flex Plan Enrollment Form
PGP OTC Form
PGP Letter of Medical Necessity Form
"Benny" Card Request Form for Saranac CSD Employees
PGP Reimbursement Voucher
PGP Flex Direct Deposit Form
Health Insurance Forms & Links
CEWW Health Insurance
Empire Blue Cross website www.empireblue.com
Empire Blue Cross Customer Service Representative (email [email protected] or call (518)419-3161 Monday Thru Friday 8:30 a.m. to 5:00 p.m.)
Empire Blue Cross Enrollment Form
Empire Blue Cross Claim Form
Ingenio Mail Order (Call 1-833-203-1739 or Fax 1-800-378-0323)
Ingenio Claim Form
Empire Blue Cross Platinum Plan 1 and 2 Benefit Descriptions
Empire Blue Cross Bronze Plan Benefit Descriptions
LiveHealth Online (telemedicine) - This benefit is covered at 100% for Plan 2 members and a cost of $11.80 for Plan 1 members. When you log in, the system references the cost of $59, however, once you elect a provider and go through the process, your actual cost will show.
LiveHealth Member Registration / LHO._Covid-19.pdf
CHIP Notice
Dept. of Labor ACA Compliance Notices
Drug Evaluation Request Form
CEWW Plan 1 Classic Traditional Comparison to Classic Blue
CEWW Plan 2 Classic Traditional Comparison to Classic Blue
Life Insurance Form
Life Enrollment Form-Saranac CSD
Policies
Medicaid Compliance Policy
Policies
Medicaid Compliance Policy
Medicaid Compliance Program
Appendix A - Confidential Disclosure Policy
Appendix B - NYS Medicaid Compliance Policy
New Employee Informational Packet
Worker's Compensation Information
HIPAA Notice
CSEA and NYSUT Vision Care Forms
CSEA Vision Employee Benefits Enrollment Form
CSEA Vision Care Benefits Description
Retirement System links
NYS Teachers' Retirement System www.nystrs.org
NYS Employees' Retirement System www.osc.state.ny.us/retire