Skip to content
  • About
  • Apply
  • Cost & aid
  • Academics
  • Campus life
  • Alumni
  • Everything else
  • CSUMB Home
  • UP

Benefit Forms

Related documents & forms

Affidavit of marriage or domestic partnership
In lieu of a marriage/domestic partnership certificate, use this affidavit form to certify your relationship for benefits.
Affidavit of parent-child relationship
A form to enroll a dependent child, other than an adopted, step, or recognized natural child, in a health plan.
Acknowledgement & Missed Premium AR Agreement
A form that acknowledges you received the benefits information and authorizes appropriate payroll deductions
Declaration of health coverage
Delcaration of health coverage
Declaration of domestic partnership
Declaration of domestic partnership
Domestic partner dependent certification form
Domestic partner certification forms
New employee enrollment worksheet
New employee enrollment worksheet
Flexcash enrollment
Flexcash enrollment
CalPERS beneficiary designation
CalPERS beneficiary designation
The Standard Insurance Co Beneficiary designation
The Standard Insurance Co beneficiary designation
Anthem claim form
Anthem Member Claim form
Dental plan enrollment form
Dental plan enrollment form
Dental claim form
Dental claim form
Vision reimbursement form
Vision reimbursement form
Computer vision confirmation form
Computer vision confirmation form
DCRA / HCRA Reimbursement form
DCRA / HCRA reimbursement form
FSA / ASIFlex debit card request
Application form for flexible spending account debit card (ASIFlex card)
2019 VSP Benefit Summary
2019 Open Enrollment Guidebook
2019 Health Benefit Summary
2019 Dental Plan Summary
2019 Health Rates Comparison Chart
2019 Health Care Reimbursement Account Brochure
2019 DCRA / HCRA Enrollment Form
2019 Dependent Care Reimbursement Account Brochure
VSP Premier Enrollment Form
Form for enrollment in VSP Premier plan
Additions and deletions worksheet
How to add or remove health or dental coverage for an employee or dependent

University Personnel

Phone
(831) 582-3389
Building
Tide Hall