Human Resources

Chapter 6 BENEFITS ADMINISTRATION

Sections in this Chapter:

6.10	Types of Leave
6.15	Education Financial Assistance
6.17	Sick Leave Insurance Program
6.20	Workers' Compensation
6.25	Health Insurance
6.30	Dental Insurance
6.35	Life Insurance
6.40	Long-term Disability Insurance
6.45	Reserved
6.50	Deferred Compensation and Tax-Sheltered Annuities
6.70	Pretax Premium Conversion Program
6.80	Flexible Spending Accounts
6.85	Donated Leave for Employees
6.87	Donated Leave for Immediate Family Members
6.90	Family and Medical Leave Act Policy

Guidance

Military Leave and Military Pay Differential

 

Related Administrative Rules:

None

Related Performance & Development Solutions Training Available:

None

Workers' Compensation Provider List:

Workers' Compensation Provider List

 

Forms Referenced in This Chapter:

Agreement for Recouping Education Payments 552-0707	PDF
Application for Education Leave and/or Education Financial Assistance 552-0304	PDF Word Document
Donated Leave
Donated Leave for Catastrophic Illness Application 552-0611	PDF
Donated Leave for Catastrophic Illness Contribution 552-0612	PDF
Donated Leave for Catastrophic Illness Request 552-0620	PDF Word Template
Donated Leave for Catastrophic Illness Tracking 552-0628	PDF
Donated Leave for Catastrophic Illness Immediate Family Member Application 552-0639	PDF
Donated Leave for Catastrophic Illness Immediate Family Member Contribution 552-0640	PDF
Donated Leave for Catastrophic Illness Immediate Family Member Request 552-0641	PDF Word Template
Donated Leave for Catastrophic Illness Immediate Family Member Tracking 552-0642	PDF
Family and Medical Leave Act (FMLA) Forms
FMLA Application & Intent to Return to Work (552-0599)	PDF
Employee Rights and Responsibilities under the Family and Medical Leave Act (WHD Publication 1420)	PDF
Leave Retention (552-0649)	PDF
Notice of Eligibility and Rights & Responsibilities (552-0730)	PDF
FMLA Return to Work Certification (552-0731)	Word
FMLA Designation Notice (552-0762)	PDF
Certification of Health Care Provider for Employee's Serious Health Condition (552-0755)	PDF
Certification of Health Care Provider for Family Member's Serious Health Condition (WH-380-F)	PDF
Certification of Qualifying Exigency for Military Family Leave (WH-384)	PDF
Certification for Serious Injury or Illness of Covered Servicemember for Military Family Leave (WH-385)	PDF
Certification for Serious Injury or Illness of a Veteran for Military Caregiver Leave (WH-385-V)	PDF
Servicemember Family Leave Tracking (552-0725)	PDF Excel Spreadsheet
Sick Leave Insurance Program (SLIP)
Sick Leave Insurance Program Enrollment Form 552-0713	PDF
SLIP Calculation Estimate Form	Excel
Group Insurance Direct Pay Continuation Form 552-0442	Word Document
SLIP Checklist for PAs	Word Document
Workers' Compensation
Workers' Compensation Benefit Election 552-0568	PDF
Workers' Compensation Wage Statement 552-0679	PDF Word Document
Workers' Compensation Status Report 552-0678	PDF Word Document
Workers' Compensation Travel Reimbursement Request 552-0680	PDF Word Document
Workers' Compensation First Report of Injury or Illness	PDF

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Updated 02/05/2013