Current employees submit completed forms to the Department of Human Resources:
Health Insurance Coverage Options and Your Health Coverage
Information regarding Covered California and Health Coverage Offered by Cal Maritime.
An employee authorization for Human Resources staff to use and/or disclose personal health plan information to an approved agency.
Leave of Absence Request Form
For employees who wish to request a leave of absence for medical, family medical leave, parental, pregnancy, military, education, personal or other leaves.
Life and AD&D Beneficiary Designation and Change
To designate or change the beneficiary of the employer-paid Life and AD&D benefit.
AD&D, Life, and Long-Term Disability Programs Offered by the Standard
- Brochure on AD&D, Life and Long-Term Programs
- Voluntary AD&D Insurance
- Voluntary Life Insurance
- Voluntary Long-Term Disability Insurance
Verification of Disability
Form for employee to give to the treating physician verifying a disability.
VSP Out-of-Network Reimbursement
Reimbursement form for employees who utilized the services of a non-VSP network provider.
VSP Video Display Terminal (VDT) Claim
Form for employees to give their vision provider when their job meets the requirements for the VDT benefit.
For more information about CSU Benefits refer to: CSU Benefits.