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HR and Benefit Forms

You must be logged into a campus computer to view these forms.  If you would like paper copies of the forms, please stop by Human Resources in Alpha Hall.

IMPORTANT NOTICE TO ALL EMPLOYEES: NEW TAX FORM FOR THE 2015 TAX YEAR

In the coming months, some employees will receive a new tax form called the 1095-C that will contain important information about their health care coverage. Although you will not need it to file your taxes for 2015 as originally reported, it is important to keep the form for your records. Employees who will receive the form include those who:

  • Were enrolled in health care coverage through Elizabethtown College at any point in 2015
  • Worked an average of 30 or more hours per week or were considered a full-time employee in 2015

Employers are required to send the 1095-C to these employees as part of the Patient Protection and Affordable Care Act, also called Obamacare. You can view the blank form here on the IRS website. We will continue to keep you informed on this important new tax document.  Please click the links below for more information:

 For questions, please contact: Brenda Spiker, extension 1183, or spikerbk@etown.edu

Access your Benefits Information Online

Click  here  to access, Empliant, our online benefits portal for employees. Once logged in you will have the ability to view your current benefits elections and update personal information related to your benefits.

2016 Benefits Information (effective January 1, 2016)

2015 Summary of Benefits and Coverage

2015 Certificates of Coverage

2015 Annual Notices

2015 Employee Benefits Brochure

Capital BlueCross website (to access provider directory, member login, etc.)

Capital BlueCross Enrollment/Change Form

CVS Caremark (prescription plan) Booklet

Davis Vision Plan

Delta Dental Enrollment/Change Form

Domestic Partner Benefit Policy

Emergency Contact Information Form

Employee Assistance Program

Ergonomics - Workstation Self-Evaluation Checklist

Family Recreation ID Request

Flexible Spending Account Payment Schedule

Flexible Spending Account Reimbursement Form - Dependent Care

Flexible Spending Account Reimbursement Form - Medical

FMLA Request Form

Liberty Mutual Insurance Flyer

Life Insurance Beneficiary Change Form

Name Badge Requests

Oil Discount Program

Pet Plan Insurance

Reasonable Accommodation Request Form

Reasonable Accommodation Request - Physician's Certificate

Service Leave Policy

 

Sick Leave Bank Provisions

 

TIAA-CREF Beneficiary Change Form

TIAA-CREF Defined Contribution Summary Plan Description 

TIAA-CREF Plans

TIAA-CREF - Salary Reduction Form

Tuition Remission / Exchange Forms

Verizon Wireless Employee Discount

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