
Enrollment Forms
Benefits Change Form
Retirement Change Form 1 Year Service Waiver
Life Insurance Evidence of Insurability Dependent Care FSA Employer Match Application
Same-Gender Domestic Partner Relationship Declaration
Same-Gender Domestic Partner Relationship Termination

Mail Order Prescription Forms
Walgreens Health Initiatives Mail Order (PPO)
Walgreens Health Initiatives Mail Order (HMOIL)
Prime Therapeutics Mail Order
Unicare Mail Order 
Long Term Care Applications
New Hire Long Term Care Application
Faculty and Staff Long Term Care Application
Spouse/Domestic Partner Long Term Care Application
Retiree Long Term Care Application |

Claim Forms
BlueCross BlueShield Health Claim Form BlueCross BlueShield Dental Claim Form
Walgreens Health Initiatives Claim Form
Prime Therapeutics Claim Form
PayFlex FSA Claim Form

Leave of Absence Forms
Short Term Disability Evidence of Good Health
Long Term Disability Evidence of Good Health
Leave of Absence Request
Short Term/Long Term Disability Claim Form
Certification of Health Care Provider
Staff Leave of Absence Provisions and Application Forms

Forms for Separating Employees
Retiree Wildcard Privileges
Retiree Health Insurance Enrollment Form
Retiree Dental Insurance Enrollment Form
Retiree Vision Insurance Enrollment Form
COBRA Health Insurance Enrollment Form
COBRA Dental Insurance Enrollment Form
COBRA Vision Insurance Enrollment Form
Automatic Withdrawal of Insurance Premiums |