Human Resources/ Open Enrollment Forms
 
2024 Health and Dental Rates (2025 Health and Dental Rates are not available yet. More information will be sent out once they become available.)
2025 Benefits Newsletter
 
Electronic W-2 Enrollment Instructions
2025 Payroll Calendar
2025 Holiday Calendar
 
Health Insurance    
 
Health Insurance Enrollment Form - PS404
2025 Choices
NYSHIP Online - Plan Participant Resource Link
Formulary Documents
Retiree Health- Voluntary Salary Deduction Agreement
 
Dental Insurance    
 
Dental Enrollment Form
Dental Mobile App
Dental Plan Booklet
Metlife Dental Benefits Link - Use this link to find a provider near you
Dental Video Links
 
Vision    
 
Vision Enrollment Form
Vision Plan Booklet
MetLife Vision Benefits Link - Use this link to find a provider near you
Vision Video Links
 
Legal  
 
Legal Enrollment Form
Legal Plan Booklet
Legal Plan Fact Sheet
Legal Plan Video Links
Legal Fee Reimbursement Schedule
 
Flexible Benefit Programs  
RFMH offers Flexible Benefit Programs with the Diversified Group.  
The benefit plans include Health Flex Spending, Dependent Care and Transportation and Parking.  
The Health Flex Spending and Dependent Care programs require re-enrollment each year.  
 
Diversified General Information    
The below information and links regarding Online Account access and the Mobile App are applicable for all benefit plans.
 
Diversified Group Online Instructions
Diversified Mobile App Instructions
 
Health Flex Spending Program    
 
Health Flex Spending Enrollment Form
Health Flex Spending FAQ
 
Dependent Care    
 
Dependent Care Enrollment Form
Dependent Care FAQ
 
Transportation and Parking    
 
Transportation and Parking Enrollment Form
Transportation and Parking Enrollment FAQ
Transportation and Parking Mobile Payment Options
 
Health Buy Out    
 
2025 Health Buy-Out Enrollment Form
Health Buy-Out Program Summary
 
Life Insurance    
 
Life Insurance Enrollment Form
Life Insurance Beneficiary Change Form
Statement of Health
Optional Life Rate Chart
 
TIAA Retirement    
 
TIAA Managing Contribution Changes
TIAA Online Enrollment Instructions
 
Contact your RFMH Human Resources/Payroll Team    
 


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