UToledo Human Resources

Benefit Forms

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

• Spousal Healthcare Eligibility Affidavit 
• Benefit Coverage 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

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 dependents of retirees.

Dependent Fee Waiver Certification-If you do not currently cover your child under any UToledo health benefit plan, please submit this          completed form along with a copy of their birth certificate to benefits@utoledo.edu. 

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