Benefit Info & Forms

The SUNY Benefits Web Site | www.suny.edu/benefits
This web site contains benefit summaries for prospective employees and detailed information organized by union, then by benefit type.

SUNY Benefit Summaries | https://www.suny.edu/benefits/benefit-summaries/

SUNY Employee Discounts | www.suny.edu/benefits/employee-discounts 

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Benefits & Forms

Health Insurance Info & Forms

• PS-404 Benefits Enrollment / Change Form
  • PS-404s Form- Additional Dependent Information Supplement for Health Insurance Enrollment
• Domestic Partner Form (must be completed with Health Insurance Enrollment Forms PS-404)
• Tax Affidavit for Domestic Partner Form
• Termination of Domestic Partnership Form
• Young Adult Option Request for Coverage
• 2026 NYSHIP Rates and Deadlines Flyer - This document outlines important information on changes to the NYSHIP health insurance premium rates for 2025. Additionally, this document communicates several important deadlines related to making changes to your health insurance plan.
• 2026 NYSHIP "Choices" Health Insurance Booklet - This booklet explains the health insurance options available to plan participants and benefits eligible employees under the New York State Health Insurance Program (NYSHIP).
• PS-409 NYSHIP Opt-Out Program Attestation Form (CSEA only)
• PS-457 - Enrollment or Recertification of an “Other” Child as a NYSHIP Dependent Form

 

Flex Spending Info & Enrollment

 

Tax Deferred Annuities

• NYS Deferred Compensation Plan
• New York's College Savings Program
• TIAA Tax Deferred Annuity
• Fidelity Tax Deferred Annuity
• VALIC Tax Deferred Annuity
• Voya Tax Deferred Annuity

 

Dental & Vision Info & Forms

• UUP
  • UUP Benefit Trust Fund
  • UUP Change of Marital Status
  • UUP Beneficiary Card
  • UUP Enrollment Card
  • UUP Change of Address
  • UUP Dental & Vision Plan
• CSEA
  • CSEA Employee Benefit Fund
  • CSEA Name Change
  • CSEA Remove Dependent
  • CSEA Enrollment Form
  • CSEA Dental and Vision Plan
• Management Confidential
  • Management Confidential Dental Enrollment Form
  • Management Confidential Dental Plan
  • Management Confidential Vision Plan
  • Management Confidential Vision Enrollment Form
• PBA NYS
  • PBA Dental Plan
  • PBA Dental Enrollment Form
  • PBA Vision Plan
  • PBA Vision Enrollment Form

 

Survivors Benefits

• Survivors Benefit

 

Paid Student Loan Forgiveness

• Federal Public Service Loan Forgiveness Program
• Public Service Loan Forgiveness Program
  • As a New York State Employee, You May Be Eligible to Have Student Loans Forgiven through this Federal Program
  • CONTACT:  Amanda Reinhart, 518-255-5423, reinhaam@Cobleskill.edu
  • More Info: oer.ny.gov/public-service-loan-forgiveness

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Leaves

Family Medical Leave Act

• SUNY Family Medical Leave Act webpage
• FMLA Rights and Responsibilities Notice
• Employee’s Serious Illness
• Family Member’s Serious Illness
• Military Family Leave
• Military Family Member’s Injury
• FMLA Notification Form
• FMLA Approval/Disapproval Form

 

NYS Paid Family Leave (UUP & M/C)

• NYS Paid Family Leave Info
• NYS Paid Family Leave Notice Form
• NYS Paid Family Leave Statement of Right Form
• SUNY PFL Application

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Retirement Benefits & Forms

SUNY Retirement at Work Portal

The SUNY Retirement at Work Portal will allow new enrollees to sign up for a retirement option and allow existing users to review their account(s), sign up for a voluntary supplemental annuity, and make changes to existing retirement accounts offered through SUNY. More links:

• Voluntary Savings Plan Guide
• SUNY Voluntary 403(b) Savings Plan Vignette - Video Overview >>
• SUNY Voluntary 403(b) Savings Plan - (VSP) Presentation >>
• ORP Enrollment Guide

• ERS, TRS & PFRS Enrollment Guide

• SUNY Retirement at Work Quick Reference Guide
• The New York State Employees' Retirement System
• The New York State Teachers' Retirement System
• Fidelity Retirement Plan
• TIAA Retirement Plan
• VALIC Retirement Plan
• VOYA Retirement Plan
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• Making Changes to 403b Retirement Accounts

• Changing Campus Locations