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	Human Resources Homepage

Use links below for the benefit plan that applies to you and
to see a list of benefit forms

>>Full-time Faculty, Full-time and Regular Part-time Administrative Staff >>Part-time Faculty >>Benefit Forms

Benefits Staff
Tel: 212-229-5671, Fax: 212-229-5884
Benefits: Extension 4942

Michele F. Davis, Director of Benefits
Contact Michele at extension 4937, with questions on all benefit related matters.

Tara Creagh , Sr. Benefits Specialist for Benefit Systems & Accounting
Contact Tara at extension 4959 with questions on all benefits-related matters.

Carol A. Laverpool, Sr. Benefits Specialist, extension 4949
Contact the Benefit Specialist with questions on Tuition Benefits, faculty and staff benefits, COBRA and disability.

Links to Benefit Plan Vendors

Dental Care Plans (Delta Dental)
www.midatlanticdeltadental.com

Flexible Spending Account Plan (EBPA)
http://select.ebpabenefits.com/thenewschool

Health Care Plans (Health Net)
www.healthnet.com

Home Owners and Auto Insurance (Liberty Mutual)
www.libertymutual.com/lm/tns

Qualified Transportation Expense (QTE) Plan (EBPA)
http://select.ebpabenefits.com/qtep/qtep.asp

Retirement Plans (TIAA-CREF)
www.tiaa-cref.org/newschool

Benefit Forms

Dental Care Plans (Delta Dental)

Full-Time Faculty, Full-Time and Regular Part-Time Administrative Staff

Part-Time Faculty ONLY

Enrollment/Change Form

Flexible Spending Account (EBPA)

Enrollment Form - 2009

Enrollment Form - 2008

Direct Deposit Form

IRS Eligible Expenses

Guidelines for Over-The-Counter (OTC) Drugs

Dependent Care Claim Form

Depedent Care Expenses Worksheet

Health Care Claim Form

Health Care Expenses Worksheet

Health Care Plan (Health Net)

Summary of Benefits - Charter $500 POS Plan - 2009

Summary of Benefits - Charter $1000 POS Plan - 2009

Summary of Benefits - Charter $500 POS Plan - 2008

Summary of Benefits - Charter $1000 POS Plan - 2008

Enrollment Form

Change/Cancellation Form

Out-of-Network Claim Questionnaire

Mental Health Claim Form HCFA-1500 (Out of Network)

Instructions on how to complete Mental Health Claim Form

CVS CareMark Prescription Mail Order Form

Instructions on how to complete CVS CareMark Prescription Mail Order Form

Request for Predetermination of Fees Form

Revocation of Authorization for Disclosure of Health Information Form

Coordination of Benefits Questionnaire

Authorization for Disclosure of Health Information Form

Liberty Mutual

How will you spend your savings?

Life Insurance Plan (The Standard)

Enrollment/Changes, Beneficiary Designation, and Optional/Additional Life Election

Long-Term Care Benefits

Qualified Transportation Expense (QTE) Plan (EBPA)

Enrollment/Change Form - 2009

Enrollment/Change Form - 2008

Direct Deposit Form

Reimbursement Claim Form

Plan Summary - 2009

Plan Summary - 2008

Tax-Deferred Annuity (TDA) Plan (TIAA-CREF)

Salary Reduction Agreement

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