Forms
Select a Category
Insurance
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Excellus BlueCross BlueShield Medical Claim Form
Link to online form
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BlueCross BlueShield Global Core Claim Form
Link to online form
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Excellus BlueCross BlueShield Authorization to Disclose Protected Health Information
Link to obtain form online
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For home delivery of ongoing medications for 90-day refills
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OptumRx Prescription Reimbursement Request Form
OptumRx Prescription Reimbursement Request Form
Dental and Vision Insurance
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For out-of-network services only
Flexible Spending Accounts (FSA)
Tuition Benefits
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Electronic Application for Tuition Grant for Dependent Children
Use this form to complete the application for Tuition Grant for Dependent Children electronically via Docusign.
Employment
Payroll
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IT-2104: NYS Employee's Withholding Allowance Certificate
All employees must complete this form in order to work in New York State
Leave Bank
Performance Assessment
Worker's Compensation
Leave of Absence/Accommodations
Address/Personal Information Update
Please update your address in Workday for Payroll, HR, and the directory.
Please note: Workday will update your address with benefits providers except TIAA. Please contact TIAA directly to update your address. You may update your online TIAA account under “My Profile”, or by phone 800-842-2252.
Contact
Human Resources
