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Benefits

Please click on the employment classifications below to see the complete list of forms or documents.


Administrator


Administrator Form Names & Descriptions

Administrative and Faculty, Chair Leave Bank Policy

Information on Administrative and Faculty, Chair leave bank.


Affidavit Of Common Law Marriage

Affidavit for Common Law Marriage.


Anthem Basic Life Form

Documents enrollment for basic life insurance benefit.


Anthem Beneficiary Designation Form

Documents beneficiary designation for life insurance benefits.


2017 CHEIBA Anthem Employee Enrollment Form

Documents CHEIBA medical and dental elections/changes. Used upon new hire, open enrollment, or qualified family status changes


Anthem Subscriber Submitted Claim

Claim form for reimbursement of eligible costs associated with health and/or dental care received by covered members.


Anthem Voluntary Term Life and Accidental Death and Dismemberment

Claim form for reimbursement of eligible costs associated with accidental death & dismemberment


APPENDIX D - Request for Reasonable Accommodation Form 2016

Form for requesting for reasonable accommodation form.


APPENDIX G - Physician Request Form 2016

Form for requesting physician request.


DCPP New Hire Election Form

Documents employee enrollment and election for participation in the Defined Contribution Pension Plan.


DCPP Vendor Change Form

Documents change for the Defined Contribution Pension Plan.


Employee Undergraduate Tuition Application and Policy

Application and policy for undergraduate tuition scholarship for eligible Administrators, Classified, and Faculty employees of the University.


Leave Bank Application Form

Facilitates donation of leave use under leave bank.


Medical Certification Form Armed Services Member

Medical Certification associated with specific leave request for Armed Services members.


Medical Certification Form Employee Condition

Documents the parameters of an employee leave for medical purposes, either for themselves or a family member.


Medical Certification Form Family Member Condition

Medical Certification associated with specific leave request for a member of the employees family.


24 HourFlex Benefit Plan Participation Form

Form for spending account enrollment and change.


24 HourFlex Enrollment Guide

24 HourFlex Enrollment Guide


PERA 140 Day Retiree Policy and Form

Designation of retirees working after retirement Under the 140-day/916 hour limit.


PERA Bill 04-257

Designation of retirement status under PERA bill 04-257


PERA 401K Contribution Form

Form used to add PERA 401K member information


PERA Member Information Form

Form used to change PERA member information.


Professional Development Fund

Click into the Professional Development tab for information and application instructions on using the Professional Development Fund for PD activities. The PD Fund is separate from the Employee Undergraduate Tuition Scholarship.

Administrator Document Names & Descriptions

Beneficiary Designation Form-CHUBB

Documents beneficiary designation for life insurance benefits.


Dependent Eligibility Documentation Required

CHEIBA Required Dependent Eligibility Documentation 


CHEIBA Employee Benefit Plan-Section 125 Form

Designates premium deductions as pre or post tax.


DCPP Retirement Plan 2016

Information on the DCPP Retirement Plan fund sponsors and new micro-site websites 


Executive Order Re: Workplace Absences Due To Influenza

Governor issued Executive Order relating to absences associated with various types of Flu.


Fitness To Return Certification

Documents eligibility to return to work following an approved medical leave.


FMLA Poster

Poster outlining rights under the Family Medical Leave Act.


Holiday Schedule 2016-2018

Alternative holiday schedule observed at the Auraria Campus.


Lactation Room on Campus

Location room on Campus.


Leave/Absence Request And Authorization

Documents the employee request for approved leave, including annual, sick, bereavement, and jury.


Medicare Part D Notice 2016

Information regarding Medicare Part D.


Military Exigency Certificate

Certification required to provide coverage to members of the military for exigent circumstances- such as pending deployment.


MSU Denver Closure Policy

University closure policy.


Mutual of Omaha Voluntary Accidental Death and Dismemberment

Form for enrollment in Accidental Death and Dismemberment Program.


P.A.L. Information Sheet

Information for Administrators and Faculty, Chair on the Participant Advocate Link for assistance with benefit claims and concerns.


Transitional Retirement Program

Detailed instructions on the transitional retirement program.


Tuition Scholarship Policy

Information on the employee tuition reimbursement program.


Worker's Compensation Policy and Providers

University worker's compensation policy and list of approved providers.

Administrator Perk Names & Descriptions

ADA Policies and Procedures 2016

Americans with Disabilities Act Policies and Procedures.


C-SEAP

Link to the Colorado State Employee Assistance Program website.


Campus Recreation at Auraria

Link to MSU Denver Campus Recreation department website.


Colorado Employee Work-Life Program

Link to employee discounts and providers through the State work-life program.


Colorado Public Employee Retirement Association (P E R A)

Access to PERA's website for information on PERA retirement benefits.


Flexible Spending Account (FSA)

Information on Flexible Spending Accounts provided by one of the FSA vendors.

Affiliate


Affiliate Form Names & Descriptions

APPENDIX D - Request for Reasonable Accommodation Form 2016

Form requesting for reasonable accommodation.


APPENDIX G - Physician Request Form 2016

Form for Physician request.


Executive Order on Workplace Violence

Governor issued Executive Order relating to absences associated with various types of Flu.


FMLA Poster

Poster outlining rights under the Family Medical Leave Act.


Medicare Part D Information

University closure policy.


PERA Bill 04-257

Designation of retirement status under PERA bill 04-257


PERA 401K Contribution Form

Form used to add PERA 401K member information


PERA Member Information Form

Form used to change PERA member information.

Affiliate Documents Names & Descriptions

Executive Order Re: Workplace Absences Due To Influenza

Governor issued Executive Order relating to absences associated with various types of Flu.


FMLA Poster

Poster outlining rights under the Family Medical Leave Act.


Holiday Schedule 2016-2018

Alternative holiday schedule observed at the Auraria campus.


Lactation Room on Campus

Location of campus lactation rooms.


Medicare Part D 2015-2016

Information regarding Medicare Part D.


Worker's Compensation Policy and Providers

University worker's compensation policy and list of approved providers.

Affiliate Perk Names & Descriptions

ADA Policies and Procedures 2016

Americans with Disabilities Act Policies and Procedures.


C-SEAP

Link to the Colorado State Employee Assistance Program website.


Colorado Employee Work-Life Program

Link to employee discounts and providers through the State work-life program.


Credit Union of Colorado

Link to the Colorado state employee credit union website.


Live Well Colorado

Link to the Live Well Colorado website.


Working Together Foundation

Link to the Working Together Foundation, an organization supporting state employees by state employees.

Chair


Chair Form Names & Descriptions

Administrative and Faculty, Chair Leave Bank Policy

Information on Administrative, Faculty and Chair leave bank.  


Affidavit Of Common Law Marriage

Affidavit for Common Law Marriage.


Anthem Basic Life Form

Documents enrollment for basic life insurance benefit. 


Anthem Beneficiary Designation Form

Documents beneficiary designation for life insurance benefits.


2017 CHEIBA Anthem Employee Enrollment Form

Documents CHEIBA medical and dental elections/changes. Used upon new hire, open enrollment, or qualified family status changes


Anthem Subscriber Submitted Claim

Claim form for reimbursement of eligible costs associated with health and/or dental care received by covered members.


Anthem Voluntary Term Life and Accidental Death and Dismemberment

Claim form for reimbursement of eligible costs associated with accidental death & dismemberment


APPENDIX D - Request for Reasonable Accommodation Form 2016

Form for requesting accommodation.


APPENDIX G - Physician Request Form 2016

For for physician request.


Application For Leave Without Pay

Complete this form to request a leave of absence without pay.


Application For Medical Leave Without Pay

Complete this form to request a leave of absence without pay.


Application For Sabbatical Leave

Complete this form to request a sabbatical leave in accordance with the Board of Trustees policies.


 DCPP New Hire Election Form
 Documents employee enrollment and election for participation in the Defined Contribution Pension Plan.

DCPP Vendor Change Form

Documents change for the Defined Contribution Pension Plan.


Employee Undergraduate Tuition Application and Policy

Application and policy for undergraduate tuition scholarship for eligible Administrators, Classified, and Faculty employees of the University.


Leave Bank Application Form

Facilitates donation of leave use under leave bank.


Leave Bank Donation Form

Facilitates donation of leave use under leave bank.


Leave/Absence Request And Authorization

Documents the employee request for approved leave, including annual, sick, bereavement, and jury.


Medical Certification Form Armed Services Member

Medical Certification associated with specific leave request for Armed Services members.


Medical Certification Form Employee Condition

Documents the parameters of an employee leave for medical purposes, either for themselves or a family member.


Medical Certification Form Family Member Condition

Medical Certification associated with specific leave request for a member of the employees family.


Military Exigency Certificate

Certification required to provide coverage to members of the military for exigent circumstances- such as pending deployment.


 24 HourFlex Benefit Plan Participation Form

Form for spending account enrollment and change.


 24 HourFlex Enrollment Guide

24 HourFlex Enrollment Guide.


PERA 140 Day Retiree Policy and Form

Designation of retirees working after retirement Under the 140-day/916 hour limit


PERA Bill 04-257

Designation of retirement status under PERA bill 04-257.


PERA 401K Contribution Form

Form used to add PERA 401K member information


PERA Member Information Form

Form used to change PERA member information.


Professional Development Fund

Click into the Professional Development tab for information and application instructions on using the Professional Development Fund for PD activities. The PD Fund is separate from the Employee Undergraduate Tuition Scholarship.

Chair Document Names & Descriptions

Beneficiary Designation Form-CHUBB

Documents beneficiary designation for life insurance benefits.


Dependent Eligibility Documentation Required

CHEIBA Required Dependent Eligibility Documentation.


CHEIBA Employee Benefit Plan-Section 125 Form

Designates premium deductions as pre or post tax.


DCPP Booklet

Defined Contribution Pension Plan summary document.


DCPP Retirement Plan 2016

Information on the DCPP Retirement Plan fund sponsors and new micro-site websites 


Executive Order Re: Workplace Absences Due To Influenza

Governor issued Executive Order relating to absences associated with various types of Flu.


FMLA Poster

Poster outlining rights under the Family Medical Leave Act.


 Holiday Schedule 2016-2018

Alternative holiday schedule observed at the Auraria campus.


Lactation Room on Campus

Location of campus lactation rooms.


Medicare Part D Notice 2016

Information regarding Medicare Part D.


Military Exigency Certificate

Certification required to provide coverage to members of the military for exigent circumstances- such as pending deployment.


MSU Denver Closure Policy

University closure policy.


Mutual of Omaha Voluntary Accidental Death and Dismemberment

Form for enrollment in Accidental Death and Dismemberment Program.


P.A.L. Information Sheet

Information regarding tax implications for domestic partner benefits.


Transitional Retirement Program

Detailed instructions on the transitional retirement program.


Tuition Scholarship Policy

Information on the employee tuition reimbursement program.


Worker's Compensation Policy and Providers

University worker's compensation policy and list of approved providers.

Chair Perk Names & Descriptions

ADA Policies and Procedures 2016

Americans with Disabilities Act Policies and Procedures.


C-SEAP

Link to the Colorado State Employee Assistance Program website.


Campus Recreation at Auraria

Link to MSU Denver Campus Recreation department website.


Colorado Employee Work-Life Program

Link to employee discounts and providers through the State work-life program.


Colorado Public Employee Retirement Association (P E R A)

Access to PERA's website for information on PERA retirement benefits.


Flexible Spending Account (FSA)

Information on Flexible Spending Accounts provided by one of the FSA vendors.


TIAA-CREF

Link to TIAA-Cref (DCPP Vendor) website.

Classified


Classified Form Names & Descriptions

APPENDIX D - Request for Reasonable Accommodation Form 2016

Form for requesting reasonable accommodation.


APPENDIX G - Physician Request Form 2016

Form for physician request.


ASI Flexible Spending Claim Form

Form used to submit eligible charges for reimbursement under the flexible spending account.


Classified Compensation Plan.

Link to state classified employee compensation plan.


Common Law Affidavit

Documents Common Law marital status for benefit purposes.


Employee Undergraduate Tuition Application and Policy

Application and policy for undergraduate tuition scholarship for eligible Administrators, Classified, and Faculty employees of the University.


Fitness To Return Certification

Documents eligibility to return to work following an approved medical leave.


Leave Bank Application Form

Facilitates donation of leave use under leave bank.


Leave Bank Donation Form

Facilitates donation of leave use under leave bank.


Leave/Absence Request And Authorization

Documents the employee request for approved leave, including annual, sick, bereavement, and jury.


Medical Certification Form Armed Services Member

Medical Certification associated with specific leave request for Armed Services members.


Medical Certification Form Employee Condition

Documents the parameters of an employee leave for medical purposes, either for themselves or a family member.


Medical Certification Form Family Member Condition

Medical Certification associated with specific leave request for a member of the employees family.


Military Exigency Certificate

Certification required to provide coverage to members of the military for exigent circumstances- such as pending deployment.


Parking Application for RTD Eco Pass

Complete this form to request a RTD Eco pass. You MUST read and initial the grey area.


Parking Payroll Deduction Application Permit

Complete this application to request a Payroll deduction permit.


Parking Payroll Deduction

Letter of parking payroll deduction.


PERA Bill 04-257

Designation of retirement status under PERA bill 04-257.


PERA 401K Contribution Form

Form used to add PERA 401K member information


PERA Member Information Form

Form used to change PERA member information.

Classified Document Names & Descriptions

Anthem Certificate of Group Life Insurance

Certificate of Insurance for Basic Life Insurance provided through the university.


Classified Leave Bank Policy

Information on Classified Leave Bank.


DCPP Booklet

Defined Contribution Pension Plan summary document.


Executive Order Re: Workplace Absences Due To Influenza

Governor issued Executive Order relating to absences associated with various types of Flu.


FMLA Poster

Poster outlining rights under the Family Medical Leave Act.


Hiring Policy PERA Retirees for 140 days

Designation of retirees working after retirement Under the 140-day/916 hour limit.


Holiday Schedule 2016-2018

Alternative holiday schedule observed at the Auraria campus.


Important Tax Information Re Domestic Partner Benefits

Information regarding tax implications for domestic partner benefits.


Lactation Room on Campus

Location of campus lactation rooms.


Medicare Part D 2015-2016

Information regarding Medicare Part D.


MSU Denver Closure Policy

University closure policy.


Parking Map

Link to Auraria Campus parking map.


Tuition Scholarship Policy

Information on the employee tuition reimbursement program.


Worker's Compensation Policy and Providers

University worker's compensation policy and list of approved providers.

Classified Perk Names & Descriptions

ADA Policies and Procedures 2016

Americans with Disabilities Act Policies and Procedures.


Benefit Solver Online Benefit Management System

Classified staff online benefit system containing plan documents, enrolled coverage, and dependent information.


C-SEAP

Link to the Colorado State Employee Assistance Program website.


Campus Recreation at Auraria

Link to MSU Denver Campus Recreation department website.


Colorado Employee Work-Life Program

Link to employee discounts and providers through the State work-life program.


Colorado Public Employee Retirement Association (P E R A)

Access to PERA's website for information on PERA retirement benefits.


Credit Union of Colorado

Link to the Colorado state employee credit union website.


Fidelity

Link to Fidelity Investments (DCPP Vendor) website.


Flexible Spending Account (FSA)

Information on Flexible Spending Accounts provided by one of the FSA vendors.


Healthline

Classified staff access to monthly Healthline newsletter published by the Dept. of Personnel and Administration.


Health Education

Link to MSU Denver Healthy Pursuits Program website.


Kaiser Permanente

Classified staff access to Kaiser Permanente's website.


Leave: Universal State Policy

Link to classified universal state policy on leave.


Live Well Colorado

Link to the Live Well Colorado website.


State Of Colorado Benefits Page

Classified staff link to State of Colorado's employee benefits website.


TIAA-CREF

Link to TIAA-Cref (DCPP Vendor) website.


Working Together Foundation

Link to the Working Together Foundation, an organization supporting state employees by state employees.


Valic

Link to Valic (DCPP Vendor) website.

Faculty


Faculty Form Names & Descriptions

Administrative and Faculty, Chair Leave Bank Policy

Information on Administrative, Faculty and Chair leave bank. 


Affidavit Of Common Law Marriage

Affidavit for Common Law Marriage.


Anthem Basic Life Form

Documents enrollment for basic life insurance benefit


Anthem Beneficiary Designation Form

Documents beneficiary designation for life insurance benefits.


 2017 CHEIBA Anthem Employee Enrollment Form

Documents CHEIBA medical and dental elections/changes. Used upon new hire, open enrollment, or qualified family status changes. 


Anthem Subscriber Submitted Claim

Claim form for reimbursement of eligible costs associated with health and/or dental care received by covered members.


Anthem Voluntary Term Life and Accidental Death and Dismemberment

Claim form for reimbursement of eligible costs associated with accidental death & dismemberment


APPENDIX D - Request for Reasonable Accommodation Form 2016

Form for requesting reasonable accommodation.


APPENDIX G - Physician Request Form 2016

Form for phsician request.


Application For Sabbatical Leave

Complete this form to request a sabbatical leave in accordance with the Board of Trustees policies.


DCPP New Hire Election Form

Documents employee enrollment and election for participation in the Defined Contribution Pension Plan


DCPP Vendor Change Form

Documents change for the Defined Contribution Pension Plan.


Employee Undergraduate Tuition Application and Policy

Application and policy for undergraduate tuition scholarship for eligible Administrators, Classified, and Faculty employees of the University.


Fitness To Return Certification

Documents eligibility to return to work following an approved medical leave.


PERA 140 Day Retiree Policy and Form

Designation of retirees working after retirement Under the 140-day/916 hour limit.


Leave Bank Application Form

Facilitates donation of leave use under leave bank.


Leave/Absence Request And Authorization

Documents the employee request for approved leave, including annual, sick, bereavement, and jury.


Medical Certification Form Armed Services Member

Medical Certification associated with specific leave request for Armed Services members.


Medical Certification Form Employee Condition

Documents the parameters of an employee leave for medical purposes, either for themselves or a family member.


Medical Certification Form Family Member Condition

Medical Certification associated with specific leave request for a member of the employees family.


Military Exigency Certificate

Certification required to provide coverage to members of the military for exigent circumstances- such as pending deployment.


24 HourFlex Benefit Plan Participation Form

Form for spending account enrollment and change.


24 HourFlex ACH Drafting Authorization

Employee direct deposit set up under 24 HourFlex. This form must be submitted directly to 24 HourFlex. 


24 HourFlex Enrollment Guide

24 HourFlex Enrollment Guide


PERA 140 Day Retiree Policy and Form  

Designation of retirees working after retirement under the 140-day/916 hour limit. 


PERA Bill 04-257

Designation of retirement status under PERA bill 04-257.


PERA 401K Contribution Form

Form used to add PERA 401K member information.


PERA Member Information Form

Form used to change PERA member information.


Professional Development Fund

Click into the Professional Development tab for information and application instructions on using the Professional Development Fund for PD activities. The PD Fund is separate from the Employee Undergraduate Tuition Scholarship.

Faculty Document Names & Descriptions

Beneficiary Designation Form-CHUBB

Documents beneficiary designation for life insurance benefits. 


Dependent Eligibility Documentation Required

CHEIBA Required Dependent Eligibility Documentation. 


CHEIBA Employee Benefit Plan-Section 125 Form

Designates premium deductions as pre or post tax. 


DCPP Booklet

Defined Contribution Pension Plan summary document.


DCPP Retirement Plan 2016

Information on the DCPP Retirement Plan fund sponsors and new micro-site websites 


Executive Order Re: Workplace Absences Due To Influenza

Governor issued Executive Order relating to absences associated with various types of Flu.


Fitness To Return Certification

Documents eligibiltiy ot return to work following an approved medical leave. 


FMLA Poster

Poster outlining rights under the Family Medical Leave Act.


Holiday Schedule 2016-2018

Alternative holiday schedule observed at the Auraria campus.


Lactation Room on Campus

Location of campus lactation rooms.


Medicare Part D Notice 2016

Information regarding Medicare Part D.


Military Exigency Certificate

Certification required to provide coverage to members of the military for exigent circumstances - such as pendng deployment.


MSU Denver Closure Policy

University closure policy.


Mutual of Omaha Voluntary Accidental Death and Dismemberment

Form for enrollment in Accidental Death and Dismemberment Program.


P.A.L. Information Sheet

Information for Administrators and Faculty, Chair on the Participant Advocate Link for assistance with benefit claims and concerns.


Transitional Retirement Program

Detailed instructions on the transitional retirement program.


Tuition Scholarship Policy

Information on the employee tuition reimbursement program.


Worker's Compensation Policy and Providers

University worker's compensation policy and list of approved providers.

Faculty Perk Names & Descriptions

ADA Policies and Procedures 2016

Americans with Disabilities Act Policies and Procedures.


C-SEAP

Link to the Colorado State Employee Assistance Program website.


Campus Recreation at Auraria

Link to MSU Denver Campus Recreation department website.


Colorado Employee Work-Life Program

Link to employee discounts and providers through the State work-life program.


Colorado Public Employee Retirement Association (P E R A)

Access to PERA's website for information on PERA retirement benefits.


Flexible Spending Account (FSA)

Information on Flexible Spending Accounts provided by one of the FSA vendors.


TIAA-CREF

Link to TIAA-Cref (DCPP Vendor) website.


accessibility

For hearing or vision impaired: view the complete tables of all resources, forms and timesheets.

If you have trouble accessing this page and need to request an alternate format, contact Ramona Morris at 303.556.2482 or by email at morriram@msudenver.edu

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Payroll Contact Information

Phone: 303.556.3030

Fax:     303.556.5023

Timesheets Fax:

Student & Temporary Employees:

303.556.5010

Classified, Administrative, & full-time Faculty:

303.556.5043

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Contact Information

890 Auraria Parkway, Suite 310

Denver, CO 80204

Office Hours:

Monday - Friday: 8am to 5pm

Phone:  303.556.3120

Fax:       303.556.5151

 

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