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Benefits


 

 Administrator

Administrator Form Names & Descriptions

Administrative and Faculty, Chair Leave Bank Policy (PDF 154 KB)

Information on Administrativ and Faculty, Chair leave bank.

Affidavit Of Common Law Marriage (Acrobat Icon 82 KB)‌

Affidavit for Common Law Marriage.

Anthem Basic Life Form (Acrobat Icon 132 KB)‌

Documents enrollment for basic life insurance benefit.

Anthem Beneficiary Designation Form (PDF 31 KB)

Documents beneficiary designation for life insurance benefits.

Anthem CHEIBA Trust Medical/Dental Enrollment And Change Form (PDF 95 KB)

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

Anthem Custom Plus Plan Description (PDF 2,072 KB)

Plan document detailing plan coverage and limitations. Closed to new members effective 1/1/10.

Anthem Point of Service Rider (PDF 2,434 KB)

Plan document detailing plan coverage and limitations.

Anthem Custom Plus Plan Description (PDF 2,072 KB)

Plan document detailing plan coverage and limitations.

Anthem Subscriber Submitted Claim (PDF 34 KB)

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 (PDF 271 KB)

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

APPENDIX D - Request for Reasonable Accommodation Form (Acrobat Icon 18 KB)

Form for requesting for reasonable accommodation form.

APPENDIX G - Physician Request Form (Acrobat Icon 34 KB)

Form for requesting physician request.

Beneficiary Designation Form-CHUBB (Acrobat Icon 7 KB)

Documents beneficiary designation for life insurance benefits.

Anthem CUSTOM PLUS Plan Summary of Benefits and Coverage (Acrobat Icon 618 KB)

Summary of benefits and coverage for Custom Plus plan documents.

Anthem HMO POS Plan Summary of Benefits and Coverage (Acrobat Icon 289 KB)

Summary of benefits and coverage for POS plan documents.

Anthem PPO Plan Summary of Benefits and Coverage (Acrobat Icon 288 KB)

Summary of benefits and coverage for PPO plan documents.

CHEIBA Benefit Summary Plan Description (2013 Plan Year) (Acrobat Icon 241 KB)

Employee Benefit Summary Plan Description for 2013.

CHEIBA Dependent Eligibility Documentation (PDF 261 KB)

CHEIBA Required Dependent Eligibility Documentation.

CHEIBA Employee Benefit Booklet (2014 Plan Year) (PDF 770 KB)

Employee Benefit Plan for 2014.

CHEIBA Employee Benefit Plan-Section 125 Form (PDF 367 KB)

Designates premium deductions as pre or post tax.

CHEIBA Medical and Dental Premiums 2013 (PDF 21 KB)

Documents for CHEIBA medical and dental premiums for 2013.

CHEIBA Medical and Dental Premiums 2014 (PDF 22 KB)

Documents for CHEIBA medical and dental premiums for 2014.

CHEIBA Trust Domestic Partnership Information and Affidavit (PDF 212 KB)

Information about CHEIBA Deomestic partnership and affidavit.

DCPP Booklet (PDF 81 KB)

Defined Contribution Pension Plan summary document.

DCPP New Hire Election Form (PDF 18 KB)

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

DCPP Vendor Change Form (20 KB)

Documents change for the Defined Contribution Pension Plan.

Domestic Partner Tax Certification (PDF 374 KB)

Certification required for designation of Domestic Partners for tax certification.

Employee Tuition Scholarship Policy Form (PDF 14 KB)

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

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 (PDF 29 KB)

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

FMLA Poster (PDF 256 KB)

Poster outlining rights under the Family Medicial Leave Act.

Holiday Schedule 2013 - 2015 (PDF 210 KB)

Alternative holiday schedule observed at the Auraria Campus.

Important Tax Information Re Domestic Partner Benefits

Infomration regarding tax implications for domestic partner benefits.

Lactation Room on Campus

Location room on Campus.

Leave/Absence Request And Authorization (PDF 53 KB)

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

Leave Bank Application Form (PDF 17 KB)

Facilitates donation of leave use under leave bank.

Medical Certification Form Armed Services Member (PDF 143 KB)

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

Medical Certification Form Employee Condition (PDF 122 KB)

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

Medical Certification Form Family Member Condition (PDF 132 KB)

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

Medicare Part D Information (60 KB)

Information regarding Medicare Part D.

Military Exigency Certificate (PDF 33 KB)

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 (PDF 55 KB)

Form for enrollment in Accidental Death and Dismemberment Program.

Parking Application for RTD Eco Pass (593 KB)

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

P.A.L. Information Sheet (PDF 137 KB)

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

Parking Guide (PDF 1,910 KB)

Link to Auraria Campus parking map.

Parking Payroll Deduction Application Permit (PDF 130 KB)

Complete this application to request a Payroll deduction permit.

Parking Payroll Deduction (439 KB)

Letter of parking payroll deduction.

Payflex Enrollment and Change Form (PDF 27 KB)

Form for spending account enrollment and change.

Payflex Flexible Direct Deposit Enrollment Form (PDF 125 KB)

Employee direct deposit set up under Payflex Flexible Spending

Payflex Flexible Spending Claim Form (PDF 55 KB)

Reimbursement claim form for flexible spending account(s).

PERA 140 Day Retiree Policy and Form (35 KB)

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

PERA Bill 04-257 (PDF 77 KB)

Designation of retirement status under PERA bill 04-257

PERA 401K Contribution Form (PDF 28 KB)

Form used to add PERA 401K member information

PERA Member Information Form (PDF 51 KB)

Form used to change PERA member information.

Pharmacy Claim Reimbursement Form (PDF 232 KB)

Reimbursement claim form for Pharmacy account(s)

Professional Development Policy and Application (71 KB)

Application for obtaining professional development compensation. Professional development is different from the tuition scholarship program.

Transitional Retirement Program (PDF 47 KB)

Detailed instructions on the transitional retirement program.

Tuition Scholarship Policy (PDF 132 KB)

Information on the employee tuition reimbursement program.

Worker's Compensation Policy and Providers (PDF 142 KB)

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

Vision Service Plan Enrollment Form (PDF 13 KB)

Facilitates enrollment in to the optional vision benefit program.

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Administrator Perk Names & Descriptions

American Disabilities Act Accommodation

Americans with Disabilities Act Policies and Procedures.

Anthem Blue Cross/Blue Shield

Administrators and Faculty, Chair access the Anthem BC/BS website for provider directories and health plan information.

C-SEAP

Link to the Colorado State Employee Assistance Program web site.

Campus Recreation at Auraria

Link to MSU Denver Campus Recreation department web site.

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 web site.

Fidelity

Link to Fidelity Investments (DCPP Vendor) web site.

Flexible Spending Account (FSA) Facts

Basic questions and answers to Flexible Spending Accounts provided by one of the FSA vendors.

Health Education

Link to MSU Denver Healthy Moves program web site.

Live Well Colorado

Link to the Live Well Colorado web site.

Working Together Foundation

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

Valic

Link to Valic (DCPP Vendor) website.

Vision Service Plan (VSP)

Administrators and Faculty, Chair access to VSP's website.

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Affiliate

Affiliate Form Names & Descriptions 

APPENDIX D - Request for Reasonable Accommodation Form 

Form requesting for reasonable accommodation.

APPENDIX G - Physician Request Form

Form for Physician request.

Executive Order on Workplace Violence (PDF 167 KB)

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 2013 - 2015

Alternative holiday schedule observed at the Auraria campus.

Lactation Room on Campus 

Location of campus lactation rooms.

Medicare Part D Information

University closure policy. 

PERA Bill 04-257 (PDF 77 KB)

Designation of retirement status under PERA bill 04-257
PERA 401K Contribution Form (PDF 28 KB)

Form used to add PERA 401K member information
PERA Member Information Form (PDF 51 KB)

Form used to change PERA member information.

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Affiliate Document Names & Descriptions
Executive Order Re: Workplace Absences Due To Influenza (PDF 471 KB)

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

FMLA Poster (PDF 256 KB)

Poster outlining rights under the Family Medical Leave Act.

Holiday Schedule 2013 - 2015 (PDF 210 KB)

Alternative holiday schedule observed at the Auraria campus.

Lactation Room on Campus (PDF 682 KB)

Location of campus lactation rooms.

Medicare Part D Information (60 KB)

University closure policy. 

Worker's Compensation Policy and Providers (PDF 142 KB)

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

BACK TO TOP

Affiliate Perk Names & Descriptions

American Disabilities Act Accommodations

Americans with Disabilities Act Policies and Procedures.

C-SEAP

Link to the Colorado State Employee Assistance Program web site.

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 web site.

Live Well Colorado

Link to the Live Well Colorado web site.

Working Together Foundation

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

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Chair

Chair Form Names & Descriptions

Affidavit Of Common Law Marriage (PDF 82 KB)

Affidavit for Common Law Marriage.

Anthem Beneficiary Designation Form (PDF 31 KB)

Documents beneficiary designation for life insurance benefits.
Anthem CHEIBA Trust Medical/Dental Enrollment And Change Form (PDF 95 KB)

Documents CHEIBA medical and dental elections/changes. Used upon new hire, open enrollment, or qualified family status changes
Anthem Subscriber Submitted Claim (PDF 34 KB)

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

APPENDIX D - Request for Reasonable Accommodation Form (Acrobat Icon 18 KB)

Form for requesting accommodation.

APPENDIX G - Physician Request Form (Acrobat Icon 34 KB)

For for physician request.

Application For Leave Without Pay (PDF 119 KB)

Complete this form to request a leave of absence without pay.
Application For Medical Leave Without Pay (PDF 119 KB)

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

Application For Sabbatical Leave (PDF 67 KB)

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

Benefit Election and Deduction Authorization Form (300 KB)

Authorizes the deduction of premiums from employee payroll.
Beneficiary Designation Form-CHUBB (PDF 7 KB)

Documents beneficiary designation for life insurance benefits.

Anthem CUSTOM PLUS Plan Summary of Benefits and Coverage (PDF 618 KB)

Summary of benefits and coverage for Custom Plus plan documents. 

Anthem HMO POS Plan Summary of Benefits and Coverage (PDF 289 KB)

Summary of benefits and coverage for POS plan documents. 

Anthem PPO Plan Summary of Benefits and Coverage (PDF 288 KB)

Summary of benefits and coverage for PPO plan documents.

CHEIBA Employee Benefit Election Form_Payroll Authorization Form (PDF 376 KB)

Authorizes the deduction of premiums from employee payroll.
CHEIBA Employee Benefit Plan-Section 125 Form (PDF 367 KB)

Designates premium deductions as pre or post tax.

CHEIBA Dependent Eligibility Documentation (PDF 261 KB)

CHEIBA Required Dependent Eligibility Documentation.

CHEIBA Medical and Dental Premiums 2013 (PDF 21 KB)

Documents for CHEIBA medical and dental premiums for 2013.

CHEIBA Medical and Dental Premiums 2014 (Acrobat Icon‌ 22 KB)

Documents for CHEIBA medical and dental premiums for 2014.

CHEIBA Trust Domestic Partnership Information and Affidavit (PDF 212 KB)

Information about CHEIBA partnership and affidavit.

DCPP New Hire Election Form (PDF 18 KB)

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

DCPP Vendor Change Form (20 KB)

Documents change for the Defined Contribution Pension Plan.

Domestic Partner Tax Certification (PDF 14 KB)

Certification required for designation of Domestic Partners for tax certification.
Employee Tuition Scholarship Policy and Application Form (PDF 217 KB)

Application and policy for tuition scholarship for eligible Administrators, Classified, and Faculty employees of the university.
Fitness To Return Certification (PDF 29 KB)

Documents eligibility to return to work following an approved medical leave.
PERA 140 Day Retiree Policy and Form (35 KB)

Designation of retirees working after retirement Under the 140-day/916 hour limit.
Leave Bank Application Form (PDF 17 KB)

Facilitates donation of leave use under leave bank.
Leave Bank Donation Form (PDF 17 KB)
Facilitates donation of leave use under leave bank.
Leave/Absence Request And Authorization (PDF 53 KB)

Documents the employee request for approved leave, including annual, sick, bereavement, and jury.
Medical Certification Form Armed Services Member (PDF 143 KB)

Medical Certification associated with specific leave request for Armed Services members.
Medical Certification Form Employee Condition (PDF 122 KB)

Documents the parameters of an employee leave for medical purposes, either for themselves or a family member.
Medical Certification Form Family Member Condition (PDF 132 KB)

Medical Certification associated with specific leave request for a member of the employees family.
Military Exigency Certificate (PDF 33 KB)

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

Parking Application for RTD Eco Pass (593 KB)

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

Parking Payroll Deduction (439 KB)

Complete this application to request a Payroll deduction permit.

Parking Payroll Deduction Application Permit (PDF 130 KB)

Letter of parking payroll deduction.

Payflex Flexible Direct Deposit Enrollment Form (PDF 125 KB)

Employee direct deposit set up under Payflex Flexible Spending
Payflex Flexible Spending Claim Form (PDF 55 KB)

Reimbursement claim form for flexible spending account(s)
PERA Bill 04-257 (PDF 77 KB)

Designation of retirement status under PERA bill 04-257
PERA Member Information Form (PDF 51 KB)

Form used to change PERA member information.

Professional Development Policy and Application (71 KB)

Application for obtaining professional development compensation. Professional development is different from the tuition scholarship program.

Vision Service Plan Enrollment Form (PDF 13 KB)

Facilitates enrollment in to the optional vision benefit program.

BACK TO TOP

Chair Document Names & Descriptions

Administrative and Faculty, Chair Leave Bank Policy (PDF 154 KB)

Information on Administrative and Faculty Leave Bank.

Anthem Custom Plus Plan Description (PDF 2,072 KB)

Plan document detailing plan coverage and limitations. Closed to new members effective 1/1/10.

Anthem Point of Service Rider (PDF 2,434 KB)

Plan document detailing plan coverage and limitations.

2014 Colorado Health Plan Description form (PDF 177 KB) 

Plan document detailing plan coverage and limitations.

CHEIBA Benefit Summary Plan Description (2013 Plan Year) (PDF 241 KB)

Employee Benefit Summary Plan Description for 2013.

CHEIBA Employee Benefit Booklet (2014 Plan Year) (PDF 770 KB)

Employee Benefit Plan for 2013.

CHEIBA Monthly Premium Rates (2013 Plan Year) (PDF 21 KB)

CHEIBA Monthly Premium Rate sheet for the 2013 plan year.

DCPP Booklet (PDF 81 KB)

Defined Contribution Pension Plan summary document.

Executive Order Re: Workplace Absences Due To Influenza (PDF 471 KB)

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

FMLA Poster (PDF 256 KB)

Poster outlining rights under the Family Medical Leave Act.

Hiring Policy PERA Retirees for 140 days (PDF 187 KB)

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

Holiday Schedule 2013 - 2015 (PDF 210 KB)

Alternative holiday schedule observed at the Auraria campus.

Important Tax Information Re Domestic Partner Benefits (PDF 89 KB)

Information regarding tax implications for domestic partner benefits.

Lactation Room on Campus (PDF 682 KB)

Location of campus lactation rooms

Medicare Part D Information (60 KB)

Information regarding Medicare Part D.

MSU Denver Closure Policy (PDF 475 KB)

University closure policy.

P.A.L. Information Sheet (PDF 137 KB)

Information regarding tax implications for domestic partner benefits.

Parking Guide (PDF 1,910 KB)

Link to Auraria Campus parking map.

Transitional Retirement Program (PDF 47 KB)

Detailed instructions on the transitional retirement program.

Tuition Scholarship Policy (PDF 132 KB)

Information on the employee tuition reimbursement program.

BACK TO TOP

Chair Perk Names & Descriptions

American Disabilities Act Accommodations

Americans with Disabilities Act Policies and Procedures.

Anthem Blue Cross/Blue Shield

Administrators and Faculty, Chair access the Anthem BC/BS website for provider directories and health plan information.

C-SEAP

Link to the Colorado State Employee Assistance Program web site.

Campus Recreation at Auraria

Link to MSU Denver Campus Recreation department web site.

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 web site.

Fidelity

Link to Fidelity Investments (DCPP Vendor) web site.

Flexible Spending Account (FSA) Facts

Basic questions and answers to Flexible Spending Accounts provided by one of the FSA vendors.

Health Education

Link to MSU Denver Healthy Moves program web site.

Live Well Colorado

Link to the Live Well Colorado web site.

TIAA-CREF

Link to TIAA-Cref (DCPP Vendor) web site.

Worker's Compensation Policy and Providers (PDF 142 KB)

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

Working Together Foundation

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

Valic

Link to Valic (DCPP Vendor) web site.

Vision Service Plan (VSP)

Administrators and Faculty, Chair access to VSP's website.

BACK TO TOP

Classified

Classified Form Names & Descriptions

APPENDIX D - Request for Reasonable Accommodation Form (PDF 18 KB)

Form for requesting reasonable accommodation.

APPENDIX G - Physician Request Form (PDF 34 KB)

Form for physician request.

ASI Flexible Spending Claim Form (112 KB)

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

Classified Compensation Plan. (219 KB)‌‎‌

Link to state classified employee compensation plan.

Common Law Affidavit (47 KB)

Documents Common Law marital status for benefit purposes.

Employee Tuition Scholarship Policy and Application Form (PDF 217 KB)

Application and policy for tuition scholarship for eligible Administrators, Classified, and Faculty employees of the university
Fitness To Return Certification (PDF 29 KB)

Documents eligibility to return to work following an approved medical leave.
Leave Bank Application Form (PDF 17 KB)

Facilitates donation of leave use under leave bank.
Leave Bank Donation Form (PDF 17 KB)

Facilitates donation of leave use under leave bank.
Leave/Absence Request And Authorization (PDF 53 KB)

Documents the employee request for approved leave, including annual, sick, bereavement, and jury.
Medical Certification Form Armed Services Member (PDF 143 KB)

Medical Certification associated with specific leave request for Armed Services members.
Medical Certification Form Employee Condition (PDF 122 KB)

Documents the parameters of an employee leave for medical purposes, either for themselves or a family member.
Medical Certification Form Family Member Condition (PDF 132 KB)

Medical Certification associated with specific leave request for a member of the employees family.
Military Exigency Certificate (PDF 33 KB)

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

Parking Application for RTD Eco Pass (593 KB)

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

Parking Payroll Deduction Application Permit (Acrobat Icon 130 KB)

Complete this application to request a Payroll deduction permit.

Parking Payroll Deduction (439 KB)

Letter of parking payroll deduction.

PERA Bill 04-257 (PDF 77 KB)

Designation of retirement status under PERA bill 04-257
PERA 401K Contribution Form (PDF 28 KB)

Form used to add PERA 401K member information
PERA Member Information Form (PDF 51 KB)

Form used to change PERA member information.

BACK TO TOP

Classified Document Names & Descriptions

Anthem Certificate of Group Life Insurance (PDF 51 KB)

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

Classified Leave Bank Policy (PDF 539 KB)

Information on Classified Leave Bank.

DCPP Booklet (PDF 81 KB) 

Defined Contribution Pension Plan summary document.

Executive Order Re: Workplace Absences Due To Influenza (PDF 471 KB) 

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

FMLA Poster (PDF 256 KB)

Poster outlining rights under the Family Medical Leave Act.

Hiring Policy PERA Retirees for 140 days (PDF 187 KB)

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

Holiday Schedule 2013 - 2015 (PDF 210 KB) 

Alternative holiday schedule observed at the Auraria campus.

Important Tax Information Re Domestic Partner Benefits (PDF 89 KB) 

Information regarding tax implications for domestic partner benefits.

Lactation Room on Campus (PDF 682 KB) 

Location of campus lactation rooms.

Medicare Part D Information (60 KB)

Information regarding Medicare Part D.

MSU Denver Closure Policy (PDF 475 KB)

University closure policy.

Parking Guide (PDF 1,910 KB)

Link to Auraria Campus parking map.

Tuition Scholarship Policy (PDF 132 KB)

Information on the employee tuition reimbursement program.

Worker's Compensation Policy and Providers (PDF 142 KB)

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

BACK TO TOP

Classified Perk Names & Descriptions

American Disabilities Act Accommodations

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 web site.

Campus Recreation at Auraria

Link to MSU Denver Campus Recreation department web site.

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 web site.

Fidelity

Link to Fidelity Investments (DCPP Vendor) web site.

Flexible Spending Account (FSA) Facts

Basic questions and answers to 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 Moves program web site.

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 web site.

State Of Colorado Benefits Page

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

TIAA-CREF

Link to TIAA-Cref (DCPP Vendor) web site.

Working Together Foundation

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

Valic

Link to Valic (DCPP Vendor) web site.

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Faculty

Faculty Form Names & Descriptions

Affidavit Of Common Law Marriage (PDF 82 KB)

Affidavit for Common Law Marriage.

Anthem Basic Life Form (PDF 132 KB)

Documents enrollment for basic life insurance benefit

Anthem Beneficiary Designation Form (PDF 31 KB)

Documents beneficiary designation for life insurance benefits.

Anthem CHEIBA Trust Medical/Dental Enrollment And Change Form (PDF 95 KB)

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

Anthem Subscriber Submitted Claim (PDF 34 KB)

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 (PDF 271 KB)

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

APPENDIX D - Request for Reasonable Accommodation Form (PDF 18 KB)‌

Form for requesting reasonable accommodation.

APPENDIX G - Physician Request Form (PDF 34 KB)

Form for phsician request.

Application For Sabbatical Leave (PDF 67 KB)

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

Beneficiary Designation Form-CHUBB (PDF 7 KB)

Documents beneficiary designation for life insurance benefits.

Anthem CUSTOM PLUS Plan Summary of Benefits and Coverage (PDF 618 KB)

Summary of benefits and coverage for Custom Plus plan documents.

Anthem HMO POS Plan Summary of Benefits and Coverage (PDF 289 KB)

Summary of benefits and coverage for POS plan documents.

Anthem PPO Plan Summary of Benefits and Coverage (PDF 288 KB)

Summary of benefits and coverage for PPO plan documents.

CHEIBA Employee Benefit Plan-Section 125 Form (PDF 367 KB)

Designates premium deductions as pre or post tax.

CHEIBA Monthly Premium Rates (2013 Plan Year) (PDF 21 KB)

CHEIBA Monthly Premium Rate sheet for the 2013 plan year.

CHEIBA Dependent Eligibility Documentation (PDF 261 KB)

CHEIBA Required Dependent Eligibility Documentation.

CHEIBA Medical and Dental Premiums 2013 (PDF 21 KB)

Documents for CHEIBA medical and dental premiums for 2013.

CHEIBA Medical and Dental Premiums 2014 (PDF 22 KB)‌

Documents for CHEIBA medical and dental premiums for 2013

CHEIBA Trust Domestic Partnership Information and Affidavit (PDF 212 KB)

Information about CHEIBA partnership and affidavit.

DCPP New Hire Election Form (PDF 18 KB)

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

DCPP Vendor Change Form (20 KB)

Documents change for the Defined Contribution Pension Plan.

Domestic Partner Tax Certification (PDF 374 KB)

Certification required for designation of Domestic Partners for tax certification.

Employee Tuition Scholarship Policy Form (PDF 14 KB)

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

Fitness To Return Certification (PDF 29 KB)

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

PERA 140 Day Retiree Policy and Form (35 KB)

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

Leave Bank Application Form (PDF 17 KB)

Facilitates donation of leave use under leave bank.

Leave/Absence Request And Authorization (PDF 53 KB)

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

Medical Certification Form Armed Services Member (PDF 143 KB)

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

Medical Certification Form Employee Condition (PDF 122 KB)

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

Medical Certification Form Family Member Condition (PDF 132 KB)

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

Military Exigency Certificate (PDF 33 KB)

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

Mutual of Omaha Voluntary Accidental Death and Dismemberment (PDF 55 KB)

Form for enrollment in Accidental Death and Dismemberment program.

Parking Application for RTD Eco Pass (593 KB)

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

Parking Payroll Deduction (439 KB)

Complete this application to request a Payroll deduction permit.

Parking Payroll Deduction Application Permit (PDF 130 KB)

Letter of parking payroll deduction.

Payflex Enrollment and Change Form (PDF 27 KB)

Form for spending account enrollment and change.

Payflex Flexible Direct Deposit Enrollment Form (PDF 125 KB)

Employee direct deposit set up under Payflex Flexible Spending

Payflex Flexible Spending Claim Form (PDF 55 KB)

Reimbursement claim form for flexible spending account(s).

PERA Bill 04-257 (PDF 77 KB)

Designation of retirement status under PERA bill 04-257

PERA 401K Contribution Form (PDF 28 KB)

Form used to add PERA 401K member information

PERA Member Information Form (PDF 51 KB)

Form used to change PERA member information.

Pharmacy Claim Reimbursement Form (PDF 232 KB)

Reimbursement claim form for Pharmacy account(s)

Professional Development Policy and Application (71 KB)

Application for obtaining professional development compensation. Professional development is different from the tuition scholarship program.

Vision Service Plan Enrollment Form (PDF 13 KB)

Facilitates enrollment in to the optional vision benefit program.

BACK TO TOP

Faculty Document Names & Descriptions

Administrative and Faculty, Chair Leave Bank Policy (PDF 154 KB)

Information on Administrative and Faculty Leave Bank.

Anthem Custom Plus Plan Description (PDF 2,072 KB)

Plan document detailing plan coverage and limitations. Closed to new members effective 1/1/10.

Anthem Point of Service Rider (PDF 2,434 KB)

Plan document detailing plan coverage and limitations.

2014 Colorado Health Plan Description form (PDF 177 KB)

Plan document detailing plan coverage and limitations.

CHEIBA Benefit Summary Plan Description (2013 Plan Year) (PDF 241 KB)

Employee Benefit Summary Plan Description for 2013.

CHEIBA Employee Benefit Booklet (2014 Plan Year) (PDF 770 KB)

Employee Benefit Plan for 2013.

CHEIBA Monthly Premium Rates (2013 Plan Year) (PDF 21 KB)

Rate chart for voluntary life insurance available to Administrators and Faculty, Chair.

DCPP Booklet (PDF 81 KB)

Defined Contribution Pension Plan summary document.

Executive Order Re: Workplace Absences Due To Influenza (PDF 471 KB)

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

FMLA Poster (PDF 256 KB)

Poster outlining rights under the Family Medical Leave Act.

Hiring Policy PERA Retirees for 140 days (PDF 187 KB)

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

Holiday Schedule 2013 - 2015 (PDF 210 KB)

Alternative holiday schedule observed at the Auraria campus.

Important Tax Information Re Domestic Partner Benefits (PDF 89 KB) 

Information regarding tax implications for domestic partner benefits.

Lactation Room on Campus (PDF 682 KB) 

Location of campus lactation rooms

Medicare Part D Information (60 KB)

Information regarding Medicare Part D.

MSU Denver Closure Policy (PDF 475 KB) 

University closure policy.

P.A.L. Information Sheet (PDF 137 KB)

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

Parking Guide (PDF 1,910 KB) 

Link to Auraria Campus parking map.

Transitional Retirement Program (PDF 47 KB)

Detailed instructions on the transitional retirement program.

Tuition Scholarship Policy (PDF 132 KB)

Information on the employee tuition reimbursement program.

Worker's Compensation Policy and Providers (PDF 142 KB)

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

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Faculty Perk Names & Descriptions

American Disabilities Act Accommodations

Americans with Disabilities Act Policies and Procedures.

Anthem Blue Cross/Blue Shield

Administrators and Faculty, Chair access the Anthem BC/BS website for provider directories and health plan information.

C-SEAP

Link to the Colorado State Employee Assistance Program web site.

Campus Recreation at Auraria

Link to MSU Denver Campus Recreation department web site.

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 web site.

Fidelity

Link to Fidelity Investments (DCPP Vendor) web site.

Flexible Spending Account (FSA) Facts

Basic questions and answers to Flexible Spending Accounts provided by one of the FSA vendors.

Healthy Moves

Link to MSU Denver Healthy Moves program web site.

Live Well Colorado

Link to the Live Well Colorado web site.

TIAA-CREF

Link to TIAA-Cref (DCPP Vendor) web site.

Working Together Foundation

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

Valic

Link to Valic (DCPP Vendor) web site.

Vision Service Plan (VSP)

Administrators and Faculty, Chair access to VSP's website.

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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 Nicole Tefft at 303.556.5034 or by email at ntefft@msudenver.edu

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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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