Benefit Forms |
Description |
Benefit eForms: Newly Eligible - New Hire Dowload Instructions |
Use this Benefit eForm to enroll in benefit plans if you are newly eligible for benefits or a new employee |
Benefit eForms: Life Event - Late Enrollment |
Use this Benefit eForm to enroll in benefit plans for a life event that is outside of the PIE. |
Benefits eForms: Change HSA Enrollment |
Use this Benefits eForm to enroll, cancel, or change Health Saving Account (HSA). |
Benefits eForms: Change Voluntary Disability |
Use this Benefits eForm to enroll, cancel, or change Voluntary Disability. |
Benefits eForms: Change Life Insurance |
Use this Benefits eForm to enroll, cancel, or change Life Insurance. |
Benefits eForms: Change AD&D |
Use this Benefits eForm to enroll, cancel, or change AD&D enrollment. |
Benefits eForms: Change Health Savings Account (HSA), Voluntary Diability, Life Insurance, and AD&D |
Use this Benefits eForm to enroll, cancel, or change Health Saving Account (HSA), Voluntary Disability, Life Insurance and AD&D |
|
The EOI is a health questionnaire that helps us determine whether you and other dependent applicants qualify for new insurance or an increase in coverage. |
|
Use this form to update your dependent's information (incorrect date of birth,mispelled name, etc.).
|
|
The purpose of this form is to:
|
|
Use this form to notify UC of the occurence of any of the qualifying events (divorce/legal separation/annulment, termination of domestic partnership,or dependent's loss of eligibility) and to request a COBRA application packet.
|