Please use one of the forms below if you are electing or changing (through a qualifying event) your health and/or dental benefits for 2021. Once you have completed and signed the form, please send in all pages of the form to Totalrewards@rochester.edu. If you are a new hire (not newly eligible) you are encouraged to enroll in your benefits online through HRMS.
- 2021 enrollment form for new hires and newly eligible employees
- 2021 enrollment form for residents and fellows
- 2021 enrollment form for members of SEIU
- 2021 qualifying event form
2021 HSA contribution form
Complete this form if you are enrolling into your HSA, updating your annual contribution to your HSA, or certifying your HSA eligibility.