UT Human Resources : Benefit Forms

ATTENTION:

ALL ITEMS LISTED ON THIS PAGE ARE FOR 2009.

FOR 2010 OPEN ENROLLMENT MATERIALS PLEASE

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HEALTHCARE FORMS

Main Campus Healthcare Election      

Health Science Healthcare Election

Main Campus Spousal/DP Eligibility Affidavit

Health Science Spousal/DP Eligibility Affidavit

Dependent Affidavit

Termination of Coverage

Prescription Reimbursement Form

TUITION FEE WAIVER

Tuition Fee Waiver

TAX DEFERRED ANNUITIES

403B Salary Reduction Agreement

RETIREMENT  

Retirement Plan Election Form                                                          

OPERS ERIP Form

FLEXIBLE SPENDING ACCOUNTS

FSA Enrollment

FSA Claim Reimbursement

LIFE INSURANCE

Main Campus Life Enrollment                  

Health Science Life Enrollment Form                     

Beneficiary Change Form 

OTHER FORMS

Change of Address Form