Forms: Vision

Below are forms for the Vision Plan. For the forms pertaining to other benefit plan, please refer to forms page for the specific plan.

Newly eligible faculty & staff may conviently elect to or waive healthcare coverage using the eBenefits, HRIS Self Service module.
Benefit Enrollment and Change ( PDF)	After hire, use this form to enroll in the Vision Pan or change the coverage for a spouse or dependent child as a result of a change in family or employment status. Must be submitted within 31 days from the date of the qualifying event.
Retiree and COBRA Vision ( PDF)	Vision Plan enrollment form for Retiree and COBRA participants.