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Retiree Forms

MVP Enrollment Form

Complete for initial enrollment or plan change. Please note that each person over the age of 65 needs to complete a separate enrollment form.

Retiree Qualifying Event/Change Form

Complete this form if you are enrolling or changing your benefit elections due to a qualifying life event, such as retirement, marriage, loss of coverage, etc.

4R Prior Service Credit Form

Service requirements may be met or enhanced with the consideration of previous UR employment or employment at another higher education facility.

5R Prior Service Credit Form

Service requirements may be met or enhanced with the consideration of previous UR employment or employment at another higher education facility.

Claim forms related to your coverage with MVP Health can be obtained on MVP’s website.



Click here for a full list of forms regarding University Benefits.