Benefits Administration
Medical Insurance
	Medical Enrollment (2009 Benefits Enrollment Form)
	CareFirst BlueCross Blue Shield Claim Form
	CareFirst BlueCross Blue Shield student certification
	CareFirst BlueCross Blue Shield disability certification
	Cigna Medical Claim Form
	CIGNA student or disabled dependent certification
	Health Insurance Waiver Form
Life Insurance
	Beneficiary Designation Form for Basic Life Insurance
	Beneficiary Designation Form for Supplemental Life Insurance
	Evidence of Insurability
	Short Term and Long Term Disability Enrollment Form 2009
Prescription Drug Program
	Caremark Prescription Claim Form
	Caremark Prescription Mail Order Form
Dental Insurance
	Aenta Dental Claim Form
Flexible Spending Accounts
	Flexible Spending Accounts Enrollment (2009 Benefits Enrollment Form)
	2008 Flexible Spending Account Request for Reimbursement Form
	2008 Debit Card Substantiation Form
	2009 Debit Card Substantiation Form
	2009 FSA Reimbursement Request Form
	Flexible Spending Direct Deposit Authorization Form
	Additional or Duplicate Debit Card Request Form
Retirement
	Please visit Benefits Administration Home Page for Retirement Information
Tuition Benefits
	Tuition Benefits Application
	Faculty and Staff Certification of Graduate Tuition Benefits
	Research Personnel Certification of Graduate Tuition Benefits
Declaration
	Declaration of Common Law Marriage
	Declaration of Domestic Partnership
	Declaration of Marriage
	Declaration of Dependent Children
HIPPA
	Authorization Form for the Release of Protected Health Information
	Plan Member Request for Account of Disclosures of Protected Health Information
	Plan Member Request for Alternative Method for Confidential Communication of Protected Health Information
	Plan Member Request to Access Protected Health Information
	Plan Member Request to Correct or Amend a Record
	Group Health Plan's Response to Request for Confidential Communications of Protected Health Information
	Group Health Plan's Response to Request to Restrict Use or Disclosure of Protected Health Information
Transportation Benefits
	Pre-tax Transportation Benefit Plan Enrollment/Change Form

To view a complete list of forms available through the Division of Human Resources please click here.