Orientation Links

 checklist  
Orientation Home
Benefits at a Glance
Checklist
Welcome from the President
E-mail Benefits
HR Home
Health Care:
Health Insurance
Dental and Vision Care
Retirement and Savings Plans:
Retirement Plan
Tax Deferred Annuities
College Savings Program
Other Benefits:
Flexible Spending Accounts
Vacation and Sick Leave
Insurances:
M/C Life Insurance
Disability Coverage
Long-Term Care Insurance
Education:
SUNY Tuition Waiver
Miscellaneous:
Payrolls Forms and Emergency Contact Information
Campus Information and Policies
When you have finished the online orientation and made your benefit elections, please complete this checklist to acknowledge you have reviewed the benefits information and completed necessary forms.  Print, sign, and bring this checklist along with all other forms to the Employee Benefits Office, Cleveland Hall 410, within 30 business days of your appointment.  Contact the Employee Benefits Office if you have any questions at 878-4821.

Name: 
Title: 
Telephone: 
Campus Appointment Date:  
Health Insurance:
  I do not wish to enroll in health insurance. Proceed to Dental and Vision Care.
Empire Plan
Blue Cross Blue Shield of WNY (Community Blue) (HMO)
Independent Health (HMO)
Opt Out Program:  complete PS-409 Form AND PS-404 Form

Health Insurance Enrollment Form (PS-404) (required if enrolling)
Coverage Type:
individual
family
If electing family coverage, attach a copy of the following documentation:
marriage certificate
if married over one year, attach current proof of financial interdependence
birth certificate(s) for all dependents
Social Security card(s) for all dependents
Dental and Vision Care:
Completed PS-404 Form
Retirement:
I wish to join the NYS Employee's Retirement System (ERS).
    Completed NYS Employees' Retirement System Application
I am presently a member of NYS Teacher's (TRS) or the NYS Employee's Retirement System (ERS).
Membership Date:Select a date     Number:    Tier:
  (enter format:  mm/dd/yyyy)
 
I am presently a member of the SUNY Optional Retirement Program.
I do not wish to join a retirement plan at this time (optional only for those with part-time appointments).
Tax Deferred Annuities and College Savings Program:
I have reviewed the information
Flexible Spending Accounts (Dependent Care Advantage and Health Care Spending accounts):
I have reviewed the information
Vacation and Sick Leave:
I have reviewed the information
Insurances:
Group Life Insurance (optional)   Application in new hire packet completed
Disability Coverage -- Income Protection Plan (IPP)

Long-Term Care Insurance (optional)     Completed NYPERL Employee Notice and Fact Sheet
Education:
I have reviewed the information
Payroll Forms and Emergency Contact Information:

NYS IT-2104 (state)
W-4 (federal)
Payroll Calendar
Direct Deposit (optional)
Emergency Contact Information Form
Credit Union (optional)
U.S. Savings Bonds (optional)
Campus Information and Policies: 

Campus Map and Directions
Employee Orientation and Handbook
Workplace Violence Prevention Training
Safety Awareness
Holidays
Employee Assistance Program
Child Care Center
Policy on Alcohol and Drug Use in the Workplace
General Policy Against Discrimination and Harassment
 
  

Copyright © 2001-2013 Human Resource Management, Buffalo State, 1300 Elmwood Avenue, Cleveland Hall 403, Buffalo, NY 14222
Telephone: (716) 878-4822, FAX: (716) 878-3068
Questions, comments, and concerns may be sent to: .