
| Quicklinks to topics in this section | |
| Medical | Dental |
| Life Insurance / AD&D | Disability |
| Worker's Comp | Retirement |
| Tuition Remission | Health Care & Dependent Care Spending |
| Family Medical Leave Act | |
MEDICAL
DENTALMedical information
- 2008 Benefits Election Form (PDF)
- Waiver form (PDF)
- Qualifying Event (PDF)
- Student Dependent form (PDF)
- HIPAA form (PDF)
- BCBS Claim Form (PDF)
LIFE INSURANCE/AD&DDental information
- 2008 Benefits Election Form (PDF)
- Waiver form (PDF)
- Qualifying Event (PDF)
- Student Dependent form (PDF)
- HIPAA form (PDF)
- Delta Claim Form (PDF)
DISABILITYLife Insurance/AD&D Information
- Request for Change (PDF)
- Evidence of Insurability (PDF)
- Beneficiary Form (PDF)
- Voluntary Life and AD&D Enrollment form (PDF)
- Voluntary Life Waiver Form (PDF)
WORKER'S COMPDisability Information
- Certification of Health Care Provider - Family (PDF)
- Definition of Serious Health Condition (PDF)
- Certification of Health Care Provider - Employee (PDF)
- Fitness for Duty Certification (PDF)
- LTD Tax Election Form (PDF)
RETIREMENTWorker's Comp Information
- Accident/Incident Form (PDF)
- Physician's Report/Work Status (PDF)
TUITION REMISSION
- 2008 Salary Reduction Agreement Voluntary 403(b) Form (PDF)
- Fidelity Change of Beneficiary (PDF)
- TIAA-CREF Change of Beneficiary (PDF)
- Carrier Change Form - MS Word or PDF
Faculty Voluntary Retirement Incentive Program
Retirement Information
- Monetary Incentive Option Application Form - MS Word or PDF
- Phased Retirement Option Application Form - MS Word or PDF
- Voluntary Resignation Form - MS Word or PDF
- Claim Release - Faculty - MS Word or PDF
- Retirement Arrangements for Tenured Faculty SPD - PDF
Tuition Remission InformationHEALTH CARE & DEPENDENT CARE SPENDING
FAMILY MEDICAL LEAVE ACTHealth Care & Dependent Care Spending Information
- Medical and Daycare Expense Claim Form (PDF)
- HIPAA (PDF)
- Direct Deposit Authorization (PDF)
- 2008 Benefits Election Form (PDF)
Family Medical Leave Act Information
- Certification of Health Care Provider - Family (PDF)
- Certification of Health Care Provider - Employee (PDF)