Benefit Forms
HEALTHCARE(Please complete your benefit elections online via your MyUT portal):
- Spousal Healthcare Eligibility Affidavit
- Adult Child Certification
- Adult Child Eligibility Requirements
Health Savings Account (HSA) Employee Election/Contribution Form
Health Savings Account (HSA) Employer Authorization Form
Flexible Spending Account Election Form
Flexible Spending Account Direct Deposit Form
Flexible Spending Claim Reimbursement Form
Prescription 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 dependents of retirees.
Dependent Fee Waiver Certification
VOLUNTARY RETIREMENT PLANS:
Ohio Deferred Compensation Enrollment Form
RETIREMENT:
LIFE INSURANCE:
Health Science Life Enrollment Form