Completed form(s) should be submitted to the HR Service Center (umurl.us/HRSC) or your HR Generalist (umurl.us/CBR).
Not seeing the form you're looking for? View all benefits-related forms and guides.
Benefits enrollment
-
Benefits Change: See FAQ "How do I change my insurance elections" for more information.
- More information on:
- Health Savings Account (HSA)
- HSA Enrollment form (PDF, 295KB)
- More information on HSAs
- Flexible Spending Account (FSA)
- FSA Enrollment form (PDF, 878KB)
- More information on FSAs
Additional forms
- Proof of relationship (PDF, 53KB)
- Sponsored adult dependent affirmation (PDF, 273KB)
- Beneficiary designation (PDF, 40KB)
- HIPAA Release of Health Information (PDF, 143KB)
- Termination of sponsored adult dependent partnership (PDF, 214KB)
Questions?
If you have questions, please contact your local HR Generalist or reach out to the HR Service Center.
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Reviewed 2021-02-01
