RCUH Policies and Procedures

RCUH Monthly Premium Rate Sheets

Related InformationRelated Policy/Procedure
RCUH Monthly Premium Rate Sheet — Active Employees3.520, 3.520A
RCUH Monthly Premium Rate Sheet — COBRA3.285, 3.520, 3.520A
RCUH Monthly Premium Rate Sheet — Retiree3.520, 3.520A, 3.560

Benefits

Form Related Policy/Procedure
RCUH Affidavit of Dependency for Tax Purposes Form (B-16)3.520
RCUH Declaration of Domestic Partnership Form (B-14)3.215, 3.520, 3.520A
RCUH Declaration of Termination of Domestic Partnership Form (B-15)3.530, 3.520A
RCUH Employee Claimant Consent Form - Workers’ Compensation (Form D-26WC)3.580
RCUH Employee Claimant Consent Form – Non-Workers’ Compensation (Form D-26NWC)3.640
RCUH Family Leave Application Form: Care for Family Member (B-11)3.660
RCUH Family Leave Application Form: Care for Self/Own Condition (B-11a)3.660
RCUH Flexible Spending Plan Enrollment/Change Form (B-5F)3.530, 3.530A
RCUH Group Health Insurance Enrollment/Change Form: Regular-Status Employees (B-5H)3.520, 3.540
RCUH Group Health Insurance Waiver Form: Regular-Status Employees (B-5Wb)3.340
RCUH Group Health ACA Insurance Enrollment/Change/Waive Form: Non-Recruited Employees (B-5A)3.340
RCUH Guidelines and Information on Domestic Partners/Reciprocal Beneficiaries
RCUH ID Card Application Form (E-18)3.610
RCUH Leave for Parent-Teacher Conference Request Form (B-1)3.520, 3.678
RCUH Life Insurance Change Form (B-5L)3.520, 3.540
RCUH Retiree Group Health & Life Insurance Enrollment Application (B-27)3.550
RCUH Supplemental Retirement Annuity (TIAA) Agreement for Salary Reduction Form (B-6)3.560
RCUH Tuition Reimbursement Program Application Authorization Form3.460
RCUH Victims Leave Form (B-21)3.650