Benefits

Benefits Forms

Below is more detailed information about your Fordham benefits listed by category. On this page you will find links to all benefit forms and summaries, summary plan descriptions and vendor contact information.

You can find all of our benefits reference material in the Benefits section according to your classification.

YOUR BENEFITS FORMS SHOULD BE SUBMITTED TO HUMAN RESOURCES
AT FACULTY MEMORIAL HALL, ROOM 506 -OR- FAX IT TO 718-817-4929

Disability/fmla/life insurance

► Admin Short Term Disability Application

► Claim for Disability Benefits for Local 153

► Claim for Disability Benefits for Local 805

► FMLA Leave Request Form

► FMLA Medical Certification for Employee

► FMLA Medical Certification for Family Member

► First Reliance Designation of Beneficiary

► Local 153 Lincoln Life Insurance Form

► Leave of Absence Request Form

PAYFLEX FLEXIBLE SPENDING

► Flexible Spending Account Enrollment Form (New Employees)

► PayFlex Reimbursement Claim Form

► PayFlex Mobile App

► PayFlex Card Flyer

► PayFlex on Using an FSA for Dental Expenses

Medical & Dental

► Cigna Medical Claim Form

► Empire Dental Claim Form

► Empire Health Insurance Claim Form

► Empire Prescription Drug Claim Form

► Medical/Dental Authorization Form

► Oxford Coordination of Benefits

► Oxford Health Plans Claim Form

► Empire ExpressScripts Mail Order Form

► Empire Enrollment Form

Retirement

► Retirement Plan Salary Reduction Agreement

► Tax-Deferred Annuity (TDA) Salary Reduction Agreement

► Fidelity Beneficiary Designation Form

► Fidelity Enrollment Application

► Fidelity Transfer/Rollover Form

► Prudential Beneficiary Designation Form

► Prudential Enrollment Application

► Prudential Transfer/RolloverForm

► TIAA-CREF Group Supplemental Retirement Annuity Enrollment Form

► TIAA-CREF Retirement Annuity Enrollment Form

► TIAA-CREF Transfer/Rollover Form

► TIAA-CREF Beneficiary Form

Tuition Remission

► Dependent and Spouse Tuition Remission Form

► Employee Tuition Remission Form

► Tuition Exchange Program Application