Comprehensive Case Type List for Self-Service Requests

This comprehensive list covers various case types for self-service requests, including administrative, benefit issues, appeals, and more. Each case type is described with quick codes, long descriptions, and creation types, along with the appropriate contact methods. The content is organized into three sections for easy reference.

• Self-Service
• Case Types
• Administrative
• Benefits
• Appeals

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1. Case Type List Self-Service Description Quick Code Long Description Case Type Provider Group Case Creation Type Admin Admin Miscellaneous ADM ADM Administrative Miscellaneous Appeals Escalated Benefit Issues FOIAS Datacap, e-mail, fax Appeals APE APE Administrative Datacap, e-mail, fax Escalated Benefit Issues FOIAS EBI EBI Benefit Health Manual FOA FOA AdministrativeDatacap, e-mail, fax QDRO QDROs QDR QDO Administrative Datacap, e-mail, fax Subpoenas Subpeonas SBP SBP AdministrativeDatacap, e-mail, fax Administrative FOI FOI FOA FOA Administrative - Miscellaneous Administrative - Miscellaneous ADM ADM Administrative

2. Case Type List Self-Service Description Connecticut Institute for the Blind Birth Certificate Quick Code Long Description Case Type Provider Group Case Creation Type CT Institute for the Blind Birth Certificate Federal Tax Change In Lieu of Birth Certificate Income Verification Miscellaneous - Benefits Purchase Service Credit Req American School at Hartford CTIB CTB Benefits Datacap, e-mail, fax DBC DBC Benefits Datacap, e-mail, fax Federal Tax Change FEDTX FTX Benefits Datacap, e-mail, fax In Lieu of Birth Certificate ILBC LBC Benefits Datacap, e-mail, fax Income Verification INVER INV Benefits Datacap, e-mail, fax Miscellaneous - Benefits Purchase Service Credit Request American School at Hartford for the Deaf MISCB MSB Benefits Datacap, e-mail, fax PSR PSR Benefits Datacap, e-mail, fax PSR PSR Benefits Datacap, e-mail, fax

3. Case Type List Self-Service Description Department of Defense Dependent School (DODDS) DD214 Quick Code Long Description Case Type Provider Group Case Creation Type DOD Dependent School (DODDS) PSR PSR Benefits Datacap, e-mail, fax DD214 PSR PSR Benefits Datacap, e-mail, fax Federal Teacher Corps Full-Time Elected Official Federal Teacher Corps PSR PSR Benefits Datacap, e-mail, fax Full-Time Elected Official PSR PSR Benefits Datacap, e-mail, fax Less Than Half Time Less Than Half Time PSR PSR Benefits Datacap, e-mail, fax Newington Childrens Hospital Teaching Newington Childrens Hospital NYC Dept of Education Outside State Teaching (OSS) PSR PSR Benefits Datacap, e-mail, fax NYC Dept of Education PSR PSR Benefits Datacap, e-mail, fax Outside State Teaching (OSS) PSR PSR Benefits Datacap, e-mail, fax

4. Case Type List Self-Service Description Previous Leave of Absence (PLOA) State Education Resource Center (SERC) State of CT Employment Non- Teaching Quick Code Long Description Case Type Provider Group Case Creation Type Previous Leave of Absence Datacap, email, fax PSR PSR Benefits State Education RC (SERC) Datacap, email, fax PSR PSR Benefits State of CT (Non- Teaching) Datacap, email, fax PSR PSR Benefits Datacap, email, fax Substitute Teaching Retirement Application - Revocation Substitute Teaching Retirement Revocation PSR PSR Benefits Staff case RETR RER Benefits Datacap, email, fax SSA Request Account Settlements Form SSA Request Account Settlements Form SSA SSA Benefits Benefits Account Settlements Benefits Account Settlements Datacap, email, fax DC DC Manual Death Case Death Case DC DC

5. Case Type List Self-Service Description Quick Code Long Description Case Type Provider Group Case Creation Type Death Case Reopened Benefits Account Settlements Benefits Account Settlements Benefits Account Settlements Benefits Account Settlements Death Case Reopened DC DC Manual Death Certificate Death Certificate DC DC Datacap, email, fax Death Settlement Misc Report a Death of Member Death Settlement Misc DC DC Datacap, email, fax Report a Death of Member Report a Death of Spouse, dependent or Co-Participant DC DC Datacap, email, fax Report a Death of Dependent Benefits Account Settlements DC DC Datacap, email, fax Spouse or Beneficiary Election Spouse or Beneficiary Election Form Benefits Account Settlements DC DC Datacap, email, fax Benefits Account Settlements Benefits Account Settlements Death Letters Death Letters DC DC Import Tool Active Death Active Death ADC ADC

6. Case Type List Self-Service Description Beneficiary Form for Plan C Beneficiary Form for Plan N Quick Code Long Description Case Type Provider Group Case Creation Type Beneficiary Form for Plan C Beneficiary Form for Plan N Address Change Add Bank Informatiom Benefits Beneficiary Benefits Beneficiary BFC BFC Datacap, email, fax BFN BFN Datacap, email, fax Address Change Add ACA ACA Benefits Change Datacap, email, fax EFT Form DBI DBI Benefits ChangeDatacap, e-mail, fax EFT Add EFT Add EFTA EFA Benefits Change Datacap, email, fax Fed Tax Add Fed Tax Add FTA FTA Benefits Change Datacap, email, fax State Tax Add State Tax Add STA STA Benefits Change Datacap, email, fax 12 Month Review 12 Month Review 12MR 12M Benefits Disability Staff case

7. Case Type List Self-Service Description Quick Code Long Description Case Type Provider Group Case Creation Type 24 Month Review 24 Month Review 24MR 24M Benefits Disability Staff case 6 Month Review Beneficiary Form for Disability Allowance 6 Month Review Disability Allowance Bene Disability Conversion Human Resource Statement Disability Income Reporting Disability Application Medical Documents 6MR 6M Benefits Disability Staff case DAB DAB Benefits Disability Datacap Disability Conversion DCNV DCN Benefits Disability Datacap, email, fax HR Statement DHR DHR Benefits Disability Datacap, email, fax Disability Income Reporting DIR DIR Benefits Disability Staff case Disability Application DISAP DAP Benefits Disability Datacap, email, fax Medical Documents DMD DMD Benefits Disability Datacap,e-mail, fax

8. Case Type List Self-Service Description Quick Code Long Description Case Type Provider Group Case Creation Type Member Personal Statement Disability Revocation Miscellaneous - Disability Add Dental Health Insurance Cancellation Health Insurance Upgrade Health Misc Member Statement DPS DPS Benefits Disability Datacap,email,fax Disability Application - Revocation Miscellaneous - Disability Add Dental Health Insurance Cancellation Health Insurance Upgrade Health Misc DREV DRV Benefits Disability Staff case MISCD MSD Benefits Disability Staff case ADD ADD Benefits Health Datacap, email, fax HIC HIC Benefits Health Datacap, email, fax HIU HIU Benefits Health Datacap, email, fax HMS HMS Benefits Health Datacap, email, fax

9. Case Type List Self-Service Description Quick Code Long Description Case Type Provider Group Case Creation Type United Health Claim Debit Account Authorization United Health Claim UHC UHC Benefits Health Datacap,email,fax Debit Account Authorization Health Subsidy - Application for $220 Health Insurance Health Insurance Application Third Party Authorization (POA/Conservator) Withdrawal of Supplemental/Voluntar y EFT Change Address/Name Change Benefits Health Account DAA DAA Staff case Health Subsidy - Application Benefits Health App HAS HAS Staff case Health Insurance Application Benefits Health App HIA HIA Datacap, email, fax Third Party Authorization TPA TPA Benefits POA Datacap, email, fax Withdrawal of Sup/Vol Benefits Withdrawal WSV WSV Datacap, email, fax EFT Change Address/Name Change N/A N/A Payroll Staging Datacap, email, fax N/A N/A Payroll Staging Datacap, email, fax

10. Case Type List Self-Service Description Quick Code Long Description Case Type Provider Group Case Creation Type United Health Claim Debit Account Authorization United Health Claim UHC UHC Benefits Health Datacap, email, fax Debit Account Authorization Health Subsidy - Application for $220 Health Insurance Health Insurance Application Third Party Authorization (POA/Conservator) Withdrawal of Supplemental/Voluntar y EFT Change Address/Name Change Benefits Health Account DAA DAA Datacap, email, fax Health Subsidy - Application Benefits Health App HAS HAS Datacap, email, fax Health Insurance Application Benefits Health App HIA HIA Datacap, email, fax Third Party Authorization TPA TPA Benefits POA Datacap, email, fax Withdrawal of Sup/Vol Benefits Withdrawal WSV WSV Datacap, email, fax EFT Change Address/Name Change N/A N/A Payroll Staging Datacap, email, fax Address/Name Change N/A N/A Payroll Staging

11. Case Type List Self-Service Description Quick Code Long Description Case Type Provider Group Case Creation Type United Health Claim Debit Account Authorization United Health Claim UHC UHC Benefits Health Datacap, email, fax Debit Account Authorization Health Subsidy - Application for $220 Health Insurance Health Insurance Application Third Party Authorization (POA/Conservator) Withdrawal of Supplemental/Voluntar y EFT Change Address/Name Change Benefits Health Account DAA DAA Datacap, email, fax Health Subsidy - Application Benefits Health App HAS HAS Datacap, email, fax Health Insurance Application Benefits Health App HIA HIA Datacap, email, fax Third Party Authorization TPA TPA Benefits POA Datacap, email, fax Withdrawal of Sup/Vol Benefits Withdrawal WSV WSV Datacap, email, fax EFT Change Address/Name Change N/A N/A Payroll Staging Datacap, email, fax Address/Name Change N/A N/A Payroll Staging

12. Case Type List Self-Service Description Quick Code Long Description Case Type Provider Group Case Creation Type Datacap, email, fax State Tax CT-W4P State Tax CT-W4P Retirement Application N/A N/A Payroll Staging Datacap, email, fax Retirement Application RETA RTA Pre-Audit Benefit Estimates Commuted Value Calculation Benefit Estimates Commuted Value Calculation Co Participant Life to Death Payment Calc 1099R Duplicate Request Adult Education Assignments Abandoned Funds Application RETA RTA DC DC Co Participant Life to Death Payment Calc 1099R Duplicate Request DC DC Datacap, email, fax 1099R 99R Fiscal 1099 Datacap, email, fax Adult Education Abandoned Funds Application AEA AEA Fiscal Datacap, email, fax AFA AFA Fiscal Withdrawal

13. Case Type List Self-Service Description Beneficiary Form - Active/Inactive Quick Code Long Description Case Type Provider Group Case Creation Type Beneficiary Form - Active/Inactive BFA BFA Fiscal Beneficiary Datacap, email, fax Fiscal Check Processing Checks Checks CKS CKS Datacap, email, fax Current Leave of Absence (CLOA) Current Leave of Absence Cost Statement Signed CLOA CLA Fiscal Datacap, email, fax Fiscal Check Processing Cost Statement Signed CSS CSS Datacap, email, fax State of CT CT Employment Teaching Form Employment Teaching Form Early Retirement Incentive Plan (ERIP) Hourly Paid Key Contact Update Form CTETF CEF Fiscal MSA Datacap, email, fax Early RET Incentive Plan(ERIP) Hourly Paid Key Contact Update Form ERIP ERP Fiscal ERIP Datacap, email, fax HP HP Fiscal Datacap, email, fax KCUF KCU Fiscal Datacap, email, fax

14. Case Type List Self-Service Description Mandatory Distribution of Voluntary or Supplemental Account Funds Quick Code Long Description Case Type Provider Group Case Creation Type Mand Dist of Vol/Sup Funds Fiscal Check Processing MDF MDF Datacap, email, fax Miscellaneous - Fiscal Member Statement Inquiry Voluntary Deductions OSS Purchase Verification Miscellaneous - Fiscal MISCF MSF Fiscal Datacap, email, fax Member Statement Inquiry MSI MSI Fiscal Datacap, email, fax Voluntary Deductions N/A N/A N/A Datacap, email, fax OSS Purchase Verification Prior Connecticut (PCS) OSSP OSP Fiscal Datacap, email, fax Prior Connecticut PCT PCT Fiscal Datacap, email, fax PRR Post Retirement 45% Rule PRR Post Retirement 45% Rule Fiscal Post Retirement PR45 P45 Datacap, email, fax PRR Break in Service Certification (PRR Break) PPR Break Certification Fiscal Post Retirement PRBC PRR Datacap, email, fax

15. Case Type List Self-Service Description PRR Pension Suspension/Reactivati on Quick Code Long Description Case Type Provider Group Case Creation Type PRR Pension Susp/Reactivation PRSR PRR Post Retirement SSA/PSD Fiscal Post Retirement Datacap, email, fax PRS PRR Post Retirement SSA/PSD Fiscal Post Retirement Datacap, email, fax PRSSA PSA Datacap, email, fax Part Time Lecturer (PTL) Part Time Lecturer PTL Returned Pension Check PTL Fiscal MSA Fiscal Check Processing Returned Pension Checks Rollover Paperwork from Member Datacap, email, fax RETPC RPC Rollover Paperwork from Member Datacap, email, fax RPM RPM Fiscal Withdrawal Datacap, email, fax Rollover TRB Form Service Contract Requests Superintendent Contact Rollover TRB Form Service Contract Request Superintendent Contact RTRB RTF Fiscal Withdrawal Datacap, email, fax SCR SCR Fiscal Datacap, email, fax SUPC SUC Fiscal

16. Case Type List Quick Code Self-Service Description Long Description Case Type Provider Group Case Creation Type Supplemental/Voluntar y Invoices Fiscal Check Processing Sup/Vol Invoices SVI SVI Datacap, email, fax Withdrawal Application Withdrawal Application WDA WDA Fiscal Withdrawal Datacap, email, fax Incoming Rollover LOAIncoming Rollover PSR PSR LOA