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 Brochure

Flexible Spending Account Election Form 

Flexible Spending Account Election Form 2014

Flexible Spending Account Direct Deposit Form

Flexible Spending Claim Reimbursement Form

Prescription Reimbursement Form

VSP Reimbursement Form

Termination of Coverage Form

 

TUITION WAIVER

Undergraduate Tuition Waiver Form

Graduate Tuition Waiver Form-This is for spouses and dependents at the graduate level only. Employee waivers (graduate and undergraduate) and   spouse/dependent undergraduate MUST use the MyUT Portal.

 

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