Open Enrollment

Open Enrollment Information 2019

Health Benefits Rate Sheet

Please return forms to Human Resources in AB113 by Dec. 7, 2018.

May I enroll in a health insurance plan after the open enrollment period?

Under Internal Revenue Service (IRS) rules, you may change your health benefits during the tax year only after one of the following qualifying events occurs:

  • Change in employee’s marital status
  • Change in employee’s number of dependents
  • Change in employment status of employee, spouse, or dependent that affects eligibility for health benefits
  • Dependent satisfies or ceases to satisfy eligibility requirements for health benefits
  • Change in place of residence or worksite of the employee, spouse, or dependent
  • Leaves of absence
  • HIPAA special enrollment rights

Medical Insurance: Excellus Simply Blue

Enrollment and Change Form

HIPAA Form

Claim Form

Excellus Simply Blue Summary of Benefits and Coverage

Excellus Telemedicine

For more information or to search for a list of current providers, please visit the Excellus BCBS website.

Prescription Coverage: Maxor Plus

Enrollment and Change Form

Maxor Plus Prior Authorization Form

HIPAA Form

Maxor Mail Order Form

Maxor Plus Summary of Benefits and Coverage

Maxor Plus Portal

For more information, please visit the Maxor Plus website.

Dental Insurance: Delta Dental

Claim Form

Enrollment and Change Form

Delta Dental Summary of Benefits and Coverage

Delta Dental Evidence of Coverage

Delta Dental Rollover Enhancement 

Dental -  Visiting the Dentist 

For more information, please visit the Delta Dental website.

Vision Coverage: Davis Vision

Enrollment and Change Form

Out of Network Claim Form

Davis Vision Summary of Benefits and Coverage

For more information, please visit the Davis Vision website.

Consolidated Omnibus Budget Reconciliation Act (COBRA)

COBRA Notice

Flexible Spending Accounts (FSA)

Plan Highlights

FSA Enrollment Brochure

Beniversal Card FAQs

FSA Enrollment Form

Change Form

Claim Form

Direct Deposit Form

Roll Over Option

Mobile App Flyer

For more information, please visit the Benefit Resource website.

Life and Long-term Disability Insurance: Sun Life

Beneficiary Designation Form

Summary of Benefits for LTD for Excluded

Colonial Voluntary Benefits

Colonial Voluntary Benefit Information

Colonial Voluntary Benefit Choices

Health Insurance Waivers

Excluded Health Insurance Waiver and Tax Option Form

Affidavit of Domestic Partnership

Affidavit of Domestic Partnership Form

Voluntary Retirement Options/Tax-Deferred Annuity Savings Plans

Tax Deferred Annuity Savings Plans - Authorized Providers

Make changes to your TDA or enroll

Retirement Options

For more information, please visit SUNY's Retirement Plan website.

Pension options include the following plans:

Retirement Forms

ERS Forms

ERS Beneficiary Designation Form

ERS Change of Address Form

ERS Name Change Notice 

ERS Request for Previous Service Form

ORP Forms

Please refer to your provider's website for beneficiary changes if enrolled in ORP: The SUNY Optional Retirement Program

ORP, 403(b), and or 457(b) Providers List

New York State Deferred Compensation Enrollment Form

New York State Deferred Compensation Roth Option

Employee Assistance Program (EAP) Information

EAP Brochure

Tuition Reimbursement Options

Mohawk Valley College Consortium

SUNY B-140W Application Form for Tuition and Fee Assistance- Return to Human Resources

SUNY Perks At Work

  • Company: SUNY
  • SUNY Code: SUNY2016