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Human Resources

2023 Plan Documents & Forms

Medical

2023 Blue Plan Benefit Summary
2023 Blue Plan SBC
2023 Blue Plan SPD
2023 Maize Plan Benefit Summary
2023 Maize Plan SBC
2023 Maize Plan SPD
2023 HealthPartners Health Plan Guide
HealthPartners Covid 19 Amendment

Carleton College Health & Welfare Comprehensive Benefit Plan

2023 Carleton College Health & Welfare Comprehensive Benefit “Wrap” Plan SPD

Miscellaneous Medical

HealthPartners Claim Form
HealthPartners Preventive Medication List
HealthPartners Excluded Medication List
Notice of a COBRA Qualifying Event
myMailRx Pharmacy Prescription Order Form

Employee Assistance Program

Employee Assistance Program (EAP) SPD

Dental

Value Plan Benefit Summary
Value Plan SPD
Comprehensive Plan Benefit Summary
Comprehensive Plan SPD
Delta Dental Claim Form

Vision

VSP Member Reference Card
2022 VSP Choice Member Benefit Summary
VSP Choice SPD

HSA

Mid-Year Contribution Changes for Health Savings Account (HSA) – Done in Workday

Workday Guide (HSA Contribution Changes)

Retirement Plans: TIAA & IOUE (Central Pension Fund)

TIAA Volume Submitter (Wrapped DC and SRA Plan) Document
TIAA Defined Contribution (403b) Summary Plan Description (SPD)
TIAA Supplement Retirement Account (SRA) Contribution Changes (Done in Workday)
- Change Retirement Contribution Guide (in Workday)
TIAA Lifetime Maximum Deferral Calculation Authorization
TIAA Annual Retirement Plan Fee Disclosure Notice
IUOE Central Pension Fund Website – Union Employees

Financial Planning Reimbursement

Application for Financial Planning Reimbursement

Flex Spending Account (Medical and Dependent Care)

Flexible Spending Summary Plan Description
Flexible Spending Claim for Reimbursement (Optum)

Leaves of Absence

CLSP (Catastrophic Leave Sharing Program) Description for Non-Exempt, Non-Union Staff
CLSP (Catastrophic Leave Sharing Program) Donation
Personal Leave of Absence Form

Life and AD&D Insurance

Group Basic Life Certificate
Group Basic AD&D Certificate
Voluntary Life Certificate
Voluntary AD&D Certificate

Life and AD&D Plan Amendments

Group Life Amendment
Voluntary Life Amendment
Group AD&D Amendment
Voluntary AD&D Amendment

Long-Term Disability (LTD)

Voluntary Long-Term Disability Certificate

Long-Term Disability Amendment

Long-Term Disability Amendment

Summary Annual Report

2020 Health and Welfare Plan Summary Annual Report (SAR)
2020 Defined Contribution Plan Summary Annual Report (SAR)

Time Off Benefits

Vacation
Sick
College Holidays & Winter Break
Floating Holidays

Travel Accident Insurance

ACM Business Travel Accident Insurance Plan and Summary Plan Document (SPD)

Other – General Information

Qualifying Events

Carleton College Human Resources

Carleton College Office of Human Resources

Strong House
Carleton College
One North College Street
Northfield, MN 55057

Email: hr@carleton.edu

Phone: 507-222-4830

Fax: 507-222-5823

Office Hours: 8:00 am–5:00 pm, Monday through Friday

Human Resources pages maintained by Matt Bolks

This page was last updated on 10 May 2023

One North College StNorthfield, MN 55057USA

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