PLEASE NOTE: You will need to have Adobe Acrobat Reader installed on your computer in order to view most of the forms. If your computer does not have Adobe Acrobat Reader installed, you may download it for free from http://www.adobe.com/products/acrobat/readstep2.html
Death Benefit Beneficiary Designation Card (for PSC-CUNY Members)
Delta Dental Plan (for PSC- CUNY Members)
Guardian Dental Plan (for PSC- CUNY Members)
Flexible Spending Accounts (FSA) Program 2014
GHI Forms
- GHI Health Insurance Claim Form (Please return to GHI)
Health Insurance Application
- Health Benefits Application PDF
- Health Benefits Buy-Out-Waiver
- Health Insurance Rates effective July 2013
- Age 26 and up Dependent
Life Insurance Application (For PSC-CUNY Members)
Medco
NYSHIP
Optical Form (for PSC- CUNY Members)
PSC-CUNY Forms
- PSC- CUNY Welfare Fund Enrollement Form
- PSC-CUNY Welfare Fund Extended Medical Benefit Claim Form (Please send the completed form, your GHI Explanation of Benefits and your itemized bill which includes the descriptions and procedure codes from the Doctor to the address on the top of the form)
Retirees- Instructional Staff
Retirement Program Election Form
Phased Retirement Program (PSC-CUNY)
New York City Teachers' Retirement System
Voluntary Savings Programs- Salary Reduction Form
WageWorks
Weight Watchers Claim Form (For PSC-CUNY Members)
Last Updated: 01/10/2019 13:00