Benefits for Clerical Local 153 Employees

---

Below is more detailed information about your Fordham benefits listed by category. On this page you will find links to all benefit summaries, summary plan descriptions, forms and vendor contact information. You may also find additional forms and reference materials in our Forms Library or Reference Library links on our main homepage.

Medical Options
Empire Blue Cross/Blue Shield

Empire Local 153 PPO Benefits Summary
Empire Enrollment Application
Empire Contact Information www.empireblue.com

HIP Healthcare

HIP Benefits
HIP Enrollment Application
Contact Information www.hipusa.com

Flexible Spending Account

2009 Flexible Spending Enrollment Application
Dependent Care Reimbursement Form
Health Care Reimbursement Form

Disability Insurance
Short Term Disability

Information on STD
Hartford Notice and Proof of Claim for Disability Benefits

Family Medical Leave Act

FMLA Policy

Life Insurance
First Reliance Standard Life Insurance

Information on Life Insurance
First Reliance Designation of Beneficiary

Retirement Plan
Clerical Retirement Summary Plan Description
Clerical Salary Retirement Agreement SRA FORM

TIAA-CREF

TIAA-CREF Clerical & Maintenance Retirement Plan Enrollment Form
TIAA-CREF TDA Enrollment Form
TIAA-CREF Investment Solutions
Contact Information (www.tiaa-cref.org/fordham)

FIDELITY INVESTMENTS

Fidelity Enrollment Application
Fidelity Investments
Contact Information (www.netbenefits.com)

PRUDENTIAL FINANCIAL

Prudential Enrollment Application
Prudential Beneficiary Designation Form
Prudential Financial 403(b) Plan
Contact Information (www.prudential.com)

Tuition Remission
Tuition Remission Guidelines
Employee Tuition Remission Form
Dependent & Spouse Tuition Remission Form