The University of Toledo

Main Campus New Hire Benefit Enrollment Guide

Below you will find the necessary forms for enrollment in Healthcare, HSA/FSA, Life Insurance & Retirement Benefits.     

For detailed Plan Summaries or Premiums please visit the 2013 Healthcare Page

1. HEALTHCARE Election Form: Use this form to elect healthcare coverage for yourself and any qualified dependents.

• If adding a spouse or dependent children to your plan, you must provide a copy of your marriage license and/or your child's birth certicficate unless we already have the copy in our files.

2. Health Savings Account (HSA) Form: Did you elect the Medical Mutual CDHP? If yes, please complete this form. If no, go to #3.

3. Spousal/Domestic Partner Healthcare Eligibility Affidavit:  Did you enroll a spouse or domestic partner on your Paramount ES or OBA/FrontPath PPO Plan? If yes, complete sections A & B on this form, print the form and have your spouse's employer complete section C if applicable.  If no, go to #4.

4. Adult Child Certification:  Are any of your dependent children age 19 or older?  If yes, please compete and print this form for every dependent age 19 or over and return with your HEALTHCARE Election form in your completed packet. If no, go to #5.

5. Chard Snyder Flexible Spending Account Enrollment Form:   If you wish to enroll in a medical or dependent care flexible spending account, please complete the enrollment form. If no, please go to #6.

6. Life Insurance Enrollment Form: Use this form to provide Beneficiary designation and additional/dependent life elections if applicable.

7. Retirement Plan Election Form: Use this form to designate your enrollment in OPERS / STRS or applicable ARP Vendor. For additional information please visit the Retirement Page. 

8. For information on HIPAA, COBRA, Michelle's Law, CHIPRA and other important notifications please visit our Required Legal Notifications Page.