The University of Toledo

Benefit Forms

2013 HEALTHCARE

ARP Vendor Change Form

Benefit Enrollment Forms:

• Election Form
• Spousal/Domestic Partner Healthcare Eligibility Affidavit
• Adult Child Certification 
• Documentation Requirements

Health Savings Account (HSA) Election/Contribution Form

HSA Distribution Request Form

Flexible Spending Account Election Form

Flexible Spending Account Direct Deposit Form

FSA Claim Reimbursement Form

Prescription Reimbursement Form

VSP Reimbursement Form

Termination of Coverage Form

 

TUITION FEE WAIVER

Tuition Fee Waiver

 

TAX DEFERRED ANNUITIES

403B Salary Reduction Agreement

 

RETIREMENT  

Retirement Plan Election Form                                                          
 

LIFE INSURANCE

Main Campus Life Enrollment                  

Health Science Life Enrollment Form                     

Beneficiary Change Form 

 

OTHER FORMS

Authorization to Release Benefit Information -- return signed, original form to: Benefits, MS 205.

Change of Address Form