Employee Benefits
Commonly Requested Forms/Reference Materials
Health Benefits
- SHBP Summary Plan Description (PDF)
- Aetna Member Handbook (PDF)
- Cigna Member Handbook (PDF)
- NJ Direct Member Handbook (PDF)
- SHBP Health and RX Enrollment Application (PDF)
- State Employee Waiver / Reinstatement (PDF)
- Affidavit of Dependency (PDF)
- NJ Direct Claim Form (PDF)
- Traditional Plan Claim Form - fill in and print (PDF)
- NJ PLUS Claim Form - fill in and print (PDF)
Dental Benefits
- Dental Plans Member Handbook
- SHBP Dental Enrollment Application (PDF)
- Affidavit of Dependency (PDF)
- SHBP Employee Dental Plans Claim Form (PDF)
Prescription Benefits
- Prescription Drug Plan Member Handbook (PDF)
- SHBP Health and RX Enrollment Application(PDF)
- Affidavit of Dependency (PDF)
- State Employee Waiver / Reinstatement (PDF)
- Caremark Prescription Mail Service Order Form (PDF)
- Caremark Prescription Reimbursement Standard Claim Form (PDF)
Vision Care
Public Employees' Retirement System (PERS)
- Retirement Application - form and full instructions (PDF)
- Retirement Application - fill-in and print (PDF)
- Disability Retirement Application - form and full instructions (PDF)
- Disability Retirement Application - fill-in and print (PDF)
- Loan Application - fill in and print (PDF)
- Request for Retirement Estimate Form - fill in and print (PDF)
- Designation of Beneficiary (PDF)
- Purchase of Service Credit (PDF)
- Application for Withdrawal Form only - fill in and print (PDF)
- PERS Enrollment Application (PDF)
Alternate Benefit Program
- ABP Enrollment Application (PDF)
- Retirement application (PDF)
- Salary Reduction Agreement (PDF)
- Investment Carrier Comparison Guide (PDF)
- Designation of Beneficiary Form (PDF)
- Long Term Disability Application (PDF)
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Deferred Compensation Plan
- Enrollment Form (PDF)
- Beneficiary Change Form (PDF)
- Deferral Rate Change Form (PDF)
- Allocation Change Form (PDF)
- Catch Up Election Form (PDF)
Tax$ave/Flexible Spending Account
- Reimbursement Claim Form(PDF)
- Enrollment Form(PDF)
- FBMC Direct Deposit Form (PDF)
- IRS Eligible Medical and Dental Expenses (PDF)
- IRS Eligible Child and Dependent Care Expenses (PDF)
- FBMC Over-The-Counter Listings (PDF)
Leave of Absence
- FMLA Poster(PDF)
- FMLA Poster-Spanish(PDF)
- Request for Leave of Absence Form (DOC)
- Certification of Healthcare Provider for Family Member’s Serious Health Condition (PDF)
- Certification of Qualifying Exigency for Military Family Leave (PDF)
- Certification for Serious Injury or Illness of Covered Servicemember for Military Family Leave (PDF)
- Short-Term Disability Form (PDF)
- Department of Labor-Temporary Disability Insurance (PDF)
- FMLA Intermittent Absence Form (DOC)
- Family Leave Insurance Poster(PDF)
- Family Leave Insurance Fact Sheet(PDF)
- State Family Leave Insurance Benefits Claim Form (FL-1)
On-The-Job Accidents
- Procedures (PDF)
- Employee Checklist (DOC)
- Employer's First Report of Accidental Injury or Occupational Illness (PDF)
