Enrollment & Claim Forms

• Cancer Screening Notification Memo
• Cancer Screening Verification Request Form
• CSEA-EBF Vision Care Enrollment Form [PDF]
• Delta Dental Claim Form [PDF]
• Delta Dental Enrollment Form [PDF]
• Employee Wellness Discounts [PDF]
• Flex Benefit Plan for Health Insurance Contributions Form [PDF]
• Hartford LTD Claim Form
• Keeping Your Coverage Up to Date [PDF]
• Mail Order Prescription Form (Caremark) [PDF]
• Prescription Drug Reimbursement Claim Form [PDF]
• Reliance Designation Beneficiary Form [PDF]
• Vision Reimbursement Form [PDF]
• OMNI 403B Application
• NYS Deferred Compensation Plan Enrollment Application

EAP Information

• EAP - Employee Assistance Group "About Us" Video
• EAP - Employee Assistance Program
  Phone Number: (800) 666-5EAP
• EAP for Educators PDF download
  Announcement from ESI on EAP for Educators

Fringe Benefit Company Websites

• Caremark - NYSHIP
• CSEA Vision
• Delta Dental
• Healthcare Marketplace 

NYSHIP Empire Plan

• Asthma Information
• At a Glance
• Claim Form
• Empire Plan Flexible Formulary Drug List
• Prescription Mail Service Order Form
• FAQ - NYSHIP Plan
• NYSHIP Enrollment Form
• On the Road With the Empire Plan
• Preventative Care Coverage Guide
• Statement of Dependence
• Statement of Disability
• Centers of Excellence Program 
• Mental Health & Substance Abuse Claim Form