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
- 2020 qualifying event form (please use this form if your qualifying event occurred in 2020)
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.