your payroll contacts are emily rhoads and danita hatfield at email@example.com or 937-327-7517.
please print and bring the completed payroll forms (1 - 5) below to your hr orientation meeting. someone from the payroll team will review your payroll forms and answer questions at your orientation.
- federal i-9 with list of acceptable documents
- general information sheet (ft employees) or general information sheet (pt employees)
- direct deposit form
- 2020 federal w-4 form
- it 4 ohio state tax form
payroll Documents & Information
your benefits contact is deanna sullivan at firstname.lastname@example.org or 937-327-7517.
Full time employees are eligible to enroll in benefits. benefits are effective on the first day of the month on or after your hire date (i.e if your hire date is on the 1st day of the month, your benefits are effective that day; if your hire date is after the 1st day of the month benefits are effective the 1st day of the following month). Children up to age 26 are eligible for medical, dental, & vision benefits. Spouses are only eligible for medical coverage if they do not have an offer of coverage with their own employer or if they are not working. Spouses are eligible for dental and vision coverage regardless of their employer's offer of coverage.
benefit enrollment forms and information - please print and bring the benefits forms (items 1 - 6 below including any additional verification or contribution forms) to your hr orientation meeting. we will review the benefit plans at the orientation meeting, answer any questions you may have, and finalize your elections.
- benefits enrollment form. complete the employee information at the top of the form and the dependent information, if enrolling dependents, on page 2. we will review the benefits together during your new hire orientation meeting so you can make your elections.
- medical coverage:
- the university offers a high deductible health plan (hdhp), also referred to as a consumer driven health plan (cdhp). please view this short video to familiarize yourself with the basic concepts behind a hdhp/cdhp.
- if enrolling a spouse in medical coverage, the spousal evidence of eligibility form and the affidavit from spouse's employer form must be completed.
- employees enrolling in the high deductible health plan (hdhp) with health savings account (hsa) must also complete the hsa payroll contribution form to indicate your contributions to the hsa and sign the HSA Terms & Conditions document.
- you will also need to set up your hsa bank account with our hsa vendor. enrollment instructions will be provided at your orientation.
- Employees enrolled in any part of Medicare are not eligible to contribute to an HSA per IRS regulations. If applicable, please read & complete the notice to medicare eligible hsa participants.
- Your HSA can be used to pay for all medical, dental & vision related expenses. In addition to an HSA, you may also elect to enroll in a limited purpose fsa (lpfsa) to pay only dental and vision expenses, thereby preserving your hsa funds for medical related expenses.
- if you do not enroll in the hdhp or if you are not eligible to contribute to an hsa, you have the option to enroll in a full flexible spending account (fsa).
- MetLife Basic Life and AD&D insurance form. All full-time employees receive 1.5x their salary in Basic Life and AD&D insurance at no cost.
- please complete, sign, print, and bring the form to your hr orientation meeting.
- you have the option to enroll in supplemental life and rates are age-based (see benefit summary document below for volumes and cost).
- also on the same form is long term disability insurance (ltd) which is available for faculty and administrative (exempt) employees (ltd is not available for non-exempt employees).
- Business Travel & Accident Insurance form. all full-time employees are enrolled at no cost. $150,000 will paid to the beneficiaries you list in the event of your death while traveling on university business.
- relocation request form. new faculty or administrative (exempt) staff awarded a full-time regular position are eligible for a relocation benefit (non-exempt employees are not eligible for the relocation benefit). relocating faculty or administrative staff must move to within 45 miles of wittenberg to be eligible for the benefit. the relocation payment is a taxable benefit.
- tiaa 403(b) salary reduction form and elective deferral agreement. there are two portions of our tiaa 403(b) plan, the defined contribution (dc) portion and the tax deferred annuity (tda) portion. full-time employees must satisfy a 1-year wait to enroll in the dc portion and to receive the university match (which has been temporarily suspended). the 1-year wait can be waived if the 403(b) verification form is completed by your immediate prior employer and returned to hr verifying they sponsored a 403(b) plan and you worked at least 1,000 hours with them in a 12 month period. if your immediate prior employer did not sponsor a 403(b) retirement plan, you will be automatically enrolled in the dc portion of the plan after 1-year of service at 5% of your salary and you will receive a 5% match. you can elect to opt-out of the automatic enrollment. all employees have the option to immediately enroll in the tda portion of the plan which is not matched.
- part-time newhires not eligible to participate in the dc portion or the plan may elect to participate in the tda portion of the plan by completing the tiaa salary reduction form and elective deferral agreement for part-time employees.
benefit summary documents - these summary documents are provided to assist you in your benefit decision making process. there is no need to print these unless you want a copy; printed copies are not needed at orientation.
- 2021 benefit rates
- anthem high deductible health plan (hdhp) with hsa summary
- anthem high deductible health plan (hdhp) preventive rx summary
- short video on the importance of preventive care
- anthem blue view vision summary
- superior dental care summary
- MetLife Basic Life & AD&D summary
- metlife employee assistance plan (eap) summary
benefit required documents - these documents are required to be provided to new hires. they are for informational purposes. no need to print these unless you want a copy; printed copies are not needed at orientation.
- Anthem HDHP Summary of benefits & Coverage
- 2020 important legal notices affecting your health plan coverage
- fmla employee rights
- hipaa notice
- 403(b) automatic enrollment and qualified default investment notice
- 403(b) fee disclosure notice
- 403(b) summary plan description
TRAINING & EDUCATION
new employees must complete two online tutorials during their first 30 days of employment. information on these tutorials will be provided at your new hire orientation.