Human Resources

All Other Pedagogical and Custodial Payroll

Pedagogues NOT on the QBank and other non-administrative employees must submit an Employee and Retiree Health Benefits Application (ERB) in order to enroll in or alter your health benefits. You can also obtain this application from your school secretary or HR representative.

Once you have completed the form and your payroll secretary or HR representative has completed and signed Section J, you must submit the completed form via fax.

Fax:  (718) 935-5215 (Attn: HR Connect Health Benefits Administration Office)

Please make sure you attach copies of all appropriate supporting documents required for eligible dependents, (e.g., marriage, domestic partnership, birth or adoption and/or student certificates). Copies need not be certified.

New hires and those adding or dropping a dependent due to a life event: Please note that you must submit your application for health insurance within 31 days of your start date. Once submitted, benefits typically take 4-6 weeks to be processed.  Late applications will be processed, but your coverage start date will be determined by the date the Benefits Administration Office processes a complete application.