Office of Human Resources

Most Requested Forms

General

• Personal Data Form
• Dependent Information Change Request
• LTD Coverage Credit Form

Health, Dental and Pharmacy Benefits

• 2013 Benefit Program Enrollment/Change Form
• MAC Penalty Exception Request Form
• Walgreens Mail Service Prescriber Fax Form
• Aetna Handicapped Dependent Forms
• Excellus BCBS Handicapped Dependent Form

Claim Forms

• Aetna Medical Benefits Claims Form
• Excellus BCBS Medical Benefits Claims Form
• Dental Claim Form

Flexible Spending Account (FSA)

• Flexible Spending Account Agreement Form
• Aetna Direct Deposit Authorization Form
• Aetna FSA Reimbursement Form
• EBS Direct Deposit Authorization Form
• EBS Health Care FSA Claim Form
• EBS Limited Purpose FSA Claim Form
• EBS Dependent Care FSA Reimbursement Form

Tuition Benefit Plans

• Tuition Benefits Service Credit Form
• Employee Tuition Waiver Form
• Employee Tuition Reimbursement Form
• Grandfathered Spouse/Domestic Partner Tuition Waiver

Retirement

• Retirement Service Credit Form