Documents/Enrolling in Your Benefits
Welcome to North Carolina A&T State University! This checklist will be used to track your progress ensuring important policies are reviewed and all required documentation is completed
and submitted to the Division of Human Resources according to prescribed deadlines. Upon completion of the checklist, please confirm your review and understanding of the
information provided by mailing a signed copy of this checklist to:
NC A&T Division of Human Resources
Attn: Benefits Office
1020 East Wendover Ave., Suite 101
Greensboro, NC 27411
Getting Started, Required Forms/Documents - Please use the checkboxes to track completion
Printed copy of this document
Reviewed the I-9 Employment Verification Information: http://www.ncat.edu/hr/documents/fn-emp/form_i-9_summary_fac-orientation.pdf
To be completed during the orientation process. A list of acceptable documents for completing the I-9 Form can be found at: http://www.ncat.edu/hr/documents/fn-emp/i9acceptable-docs.doc . Original documentation is required.
Reviewed Equal Opportunity and Non-Discrimination Policy Statement: http://www.ncat.edu/hr/documents/EEO-ER/eeo_and_non-descrimination_policy.pdf
Completed State Tax Form: http://www.dor.state.nc.us/downloads/nc-4.pdf
Completed Federal Tax Form: http://www.irs.gov/pub/irs-pdf/fw4.pdf
Completed Direct Deposit Form: http://www.ncat.edu/hr/documents/banner-hr/direct_deposit_form.xls
Completed Directory Information Form: http://www.ncat.edu/hr/documents/Other/faculty_staff_directory.doc
Reviewed North Carolina A&T State University Policy Information: http://www.ncat.edu/hr/policies/index.html
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Documents/Enrolling in Your Benefits
Please use the checkboxes to track completion
Plan
Health Benefits
How to Enroll
Enrollment Deadline
State Health Plan Enrollment Website
ncat.hrintouch.com
All employees must complete online enrollment within 30 days of their
employment date to select either the Basic 70/30 or the Standard 80/20 PPO
Plan
There is no exclusion for pre-existing condition(s) if you enroll with 30 days of
your employment date
NCFlex Benefits
Dental, Vision, Health Care FSA, Dependent
Day Care FSA, Cancer, Critical Illness,
Voluntary Group Term Life, Core AD&D,
Voluntary AD&D
Short-Term Disability (DIP-NC)
NCFlex Enrollment Website
www.ncflexonline.org
All employees must complete online enrollment within 30 days of their
employment date
You will automatically be enrolled for coverage.
N/A
www.nctreasurer.com/ret/DINCP%20Employer/ShortTerm-Pre-Long-Term-Disability.pdf
Long-Term Disability (DIP-NC)
You will automatically be enrolled for coverage.
N/A
Supplemental Disability Plan
 Enroll through Liberty Mutual by completing the
All SPA employees must complete enrollment within 30 days of their
employment date.
enrollment forms located online at
www.northcarolina.edu/hr/Liberty_Mutual_LTD_
Enrollment_and_Change_Form.pdf
All EPA Employees must complete enrollment within 60 days of their
employment.
 Enroll through The Standard by completing the
enrollment forms located online at
www.standard.com/eforms/4781.pdf
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Documents/Enrolling in Your Benefits
TSERS
Participation is mandatory for SPA employees. You N/A
will automatically be enrolled unless you enroll in the
ORP, if eligible
You do not need to complete an enrollment form;
however, you must designate a beneficiary by
completing the following online forms located at
https://orbit.myncretirement.com/Orbit/Info/Pages/Li
stAllForms.aspx?formCat=F3BENDESG
 Form 2DB - Designating Beneficiary(ies) for the
Death Benefit
 Form 2RC - Designating Beneficiary(ies) for The
Retirement System Return of Contributions
ORP
You must complete the following forms:
 Form ORP-1 The University of North Carolina
Optional Retirement Program (ORP) Election
And Forfeiture Agreement
If eligible, you must enroll within 60 days of your employment date or you will
automatically be enrolled in TSERS. Forms are distributed by your campus
Benefits Department.
 ORP Carrier Enrollment Application (Complete
the ORP Carrier form(s) for the carrier you want
for your contributions and the University
contributions.)
http://www.northcarolina.edu/hr/ORP1.pdf
403(b) Plan
 Visit
You can enroll at any time
www.northcarolina.edu/hr/ga/benefits/retirement
/Suppmtl-Ret/403bMain.htm
 Complete a Salary Reduction Agreement (form
and instructions available on the website)
 Enroll in the Plan with Fidelity and/or TIAACREF
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Documents/Enrolling in Your Benefits
457 Plan
 Visit
You can enroll at any time
www.retirement.prudential.com/cws/ncplans
 Complete an NC 457 Deferred Compensation
Plan Enrollment Form (forms and instructions
available on the website)
 Send the form to:
NC Plans Processing Center, PO Box 5340,
Scranton, PA 18505, or fax to 1-866-439-8602
401(k) Plan
 Visit
You can enroll at any time
www.retirement.prudential.com/cws/ncplans
 Complete an NC 401(k) Plan Enrollment Form
(forms and instructions available on the website)
 Send the form to:
NC Plans Processing Center, PO Box 5340,
Scranton, PA 18505, or fax to 1-866-439-8602
If you have questions or need additional information on any of the topics covered in the online orientation, please contact the Benefits Office at (336) 334-7226.
Employee Certification:
I have read the information provided and completed all necessary forms. Based upon the information I have read, I understand my benefit options and know how to obtain assistance if
needed.
Print Name:
Department:
North Carolina A&T State University
Signature:
Date:
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