Benefits Forms
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- Affidavit of Domestic Partnership/Acknowledgment of Domestic Partnership
- Flu Vaccination Consent Form
- Life Beneficiary Designation
- Supplemental Life Evidence of Insurability
- MMO Student Certification
- Meritain Full-Time Student Verification Form
Benelect Forms
- Benelect 2009 Enrollment Form
- Benelect 2009 Change of Status
- 2009 Benelect cost structure for full-time (working 37.5 hr/wk) 100% Nonexempt Price Sheet
- 2009 Benelect cost structure for three-quarter-time (nonexempt working 28-37.4 hr/wk) 75% Nonexempt Price Sheet
- 2009 Benelect cost structure for half-time (nonexempt working 18.75 to 27.9 hr/wk) 50% Nonexempt Price Sheet
- 2009 Benelect cost structure for full-time (exempt working 40 hr/wk) 100% Exempt Price Sheet
- 2009 Benelect cost structure for three-quarter-time (exempt working 30-39.9 hr/wk) 75% Exempt Price Sheet
- 2009 Benelect cost structure for half-time (exempt working 20-29.9 hr/wk) 50% Exempt Price Sheet
Education
- Certification for Tuition Waiver
- Affidavit of Qualification for Tuition Waiver Tax Exemption
- Child's Proof of Dependency Affidavit
- Certification for Tuition Reimbursement #HR20050101
Insurance Claims
- Dentemax Claim Form
- Flex Dependent Care Reimbursement Acct Claim Form
- Flex Health Care Reimbursement Acct Claim Form
- Medical Mutual of Ohio (MMO) Claim Form
- VSP Out-of-Network Reimbursement Form
- Union Eye Care Reimbursement Form
Leave of Absence
- Leave of Absence Form
- Personal Medical Certificate of Health Care Provider
- Family Medical Certificate of Health Care Provider
- Servicemember Family Medical Certificate of Health Care Provider
- Certification of Qualifying Exigency
- Certification By a Health Care Provider for Returning to Work
Retirement
- Retirement Plan B Beneficiary Designation
- Salary Reduction Agreement and Investment Election Form (Plan A)
- Salary Reduction Agreement and Investment Election Form (Plan C)
- 457b Deferred Compensation Change Form
