UToledo Human Resources


BENEFIT FORMS


HEALTHCARE(Please complete your benefit elections online via your MyUT portal):

Health Savings Account (HSA) Employee Election/Contribution Form

Health Savings Account (HSA) Employer Authorization Form

Flexible Spending Account Election Form - (2020)

Flexible Spending Account Election Form - (2021)

Flexible Spending Account Direct Deposit Form

Flexible Spending Claim Reimbursement Form

Prescription Reimbursement Form

VSP Reimbursement Form

TUITION WAIVER:

Tuition Waiver Form- To be used for employee out of state tuition (undergraduate and graduate), dependent out of state tuition (undergraduate), and all retirees.

       Dependent Fee Waiver Certification

VOLUNTARY RETIREMENT PLANS:

Ohio Deferred Compensation Enrollment Form

 

RETIREMENT:  

Retirement Plan Election Form                                                      

 

LIFE INSURANCE:

Main Campus Life Enrollment                  

Health Science Life Enrollment Form                     

Beneficiary Change Form 

 

 

Last Updated: 10/14/20