Available below for your convenience is information and/or links to downloadable forms related to medical benefits, disability, life insurance, domestic partner benefits, retirement, flexible spending accounts and general employment.
Dental and Vision Plan
Domestic Partner Benefits
- Domestic Partner Benefits Policy (for policy details and definitions)
- Affidavit of Marriage or Domestic Partnership (to apply for domestic partner insurance coverage)
- Declaration of Dependent Tax Status
- IRS Worksheet for Dependent Tax Status
- Affidavit of Termination of Domestic Partnership (to cancel existing domestic partner coverage)
General Employment Forms
Life Insurance and Long Term Disability
- Life Insurance Certificate – Faculty
- Life Insurance Certificate – Non-faculty Employees
- Supplemental Term Life Insurance Overview
- Supplemental Term Life Insurance Enrollment Form
- Grief Counseling Information
- Will Preparation FAQ
- Travel Assist
- Long Term Disability Certificate – Faculty
- Long Term Disability Certificate – Non-faculty Employees
Medical Benefits
- National Plus Pharmacy Network
- HSA Eligible Expenses
- HSA Ineligible Expenses
- Medical Plan Cost Calculator
- Virtual Doctor’s Visit
- Spousal Affidavit
- Highmark PPO Benefit Grid (for employees hired prior to 9/1/19)
- PPO Medical Rates (for employees hired prior to 9/1/19)
- Highmark PPO SBC (for employees hired prior to 9/1/19)
- Highmark HDHP Benefit Grid
- HDHP Medical Rates
- Highmark HDHP SBC
Payroll
- Biweekly Payroll Schedule (for non-exempt employees)
- Biweekly Payroll/Attendance Report (for non-exempt employees)
- Local Services Tax Exemption Certificate (to apply for LST exemption)
- Summer/Break Non-Allegheny Student Employment Form
- Summer/Break Non-Allegheny Student Timesheet
- Direct Deposit Form
Performance Reviews
Nonexempt:
- Nonexempt Performance Review Instructions
- Nonexempt Office/Support Staff Annual Review Form
- Nonexempt Office/Support Staff Supervisor Form
- Nonexempt Service/Maintenance Annual Review Form
- Nonexempt Service/Maintenance Supervisor Form
Exempt:
Retirement Planning
- Verification of Employment for Participation in Retirement Annuity (RA)
- Salary Deferral Agreement (to apply for, or to alter retirement deductions)
- Cornerstone Quarterly Newsletter-March 31, 2023
- Cornerstone Booking Flyer (to schedule a one-on-one meeting with one of Participant Services consultants)
Section 125/Flexible Spending Accounts
Short Term Disability, FMLA, and/or Child-bearing Disability Leave
- FMLA Request Form (to apply for short-term disability leave or a leave of absence)
- Certification of Health Care Provider for FMLA Leave
- Initial Statement of Claim for Short-Term Disability Application (to apply for short-term disability leave or a leave of absence)
- Attending Physician’s Statement for Short-Term Disability Leave (to apply for short-term disability leave or a leave of absence)
- Authorization for Use in Obtaining Information for Short-Term Disability Leave (to apply for short-term disability leave or a leave of absence)
Workers' Compensation
- Employee Injury Report Form (to report an accident)
- Panel of Providers (for a list of area providers)
- Notice of Rights and Duties
- Workers’ Compensation Information