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Total Rewards forms and guides

Browse Forms and Guides or filter by topic, audience, or program.

Audience
Program
Topic
Document Type
 
Name/Description File type
2017 benefits premiums

The 2017 benefits premiums are found within the 2017 Total Rewards guide.

PDF
2017 comparsion charts

The 2017 medical plan comparison chart can be found as part of the 2017 Total Rewards guide.

PDF
Custom Network Plan slicksheet

One-page summary of the Custom Network Plan offered by University of Missouri System.

PDF
Dental slicksheet

One-page summary overview of the university Dental Plan.

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Flexible Spending Account slicksheet

One-page summary of the Flexible Spending Accounts offered by the University of Missouri System.

PDF
Health Savings Account slicksheet

One-page summary of the Health Savings Account offered by the University of Missouri System

PDF
Healthy Savings Plan slicksheet

One-page summary of the Healthy Savings Plan offered by UM System.

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PPO Plan slicksheet

One-page summary of the PPO Plan offered by the University of Missouri System.

PDF
Vision slicksheet

One-page summary overview of the university Vision Plan.

PDF
Voluntary Retirement Plans (VRP) highlights

Provides a high-level overview of the Voluntary Retirement Plan options for both benefit-eligible and non-benefit eligible faculty and staff.

PDF
ERIP: Getting Started in Your University of Missouri Core Retirement and Voluntary Retirement Plans

Guide to the university’s Employee Retirement Investment Plan (ERIP).

PDF
Retirement, Disability, and Death Plan (RDD) getting started guide

Getting started guide for employees whose core retirement plan is the Retirement, Disability, and Death (RDD) plan.

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Summary of your core retirement plan: Employee Retirement Investment Plan (ERIP)

The ERIP has two components: (1) the defined benefit portion and (2) the defined contribution portion. This document summarizes both.

PDF
Summary of your core retirement plan: Retirement, Disability, and Death Plan overview

This is a one-page overview of the core retirement plan, the Retirement, Disability, and Death Plan (RDD).

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Voluntary Retirement Plans (VRP) getting started guide

Guide to help individuals get started in the Voluntary Retirement Plans offered by the University of Missouri System.

PDF
Beneficiary designation form for active employees

Active employee Beneficiary Designation Form to be used for beneficiary designations for Basic Life, Supplemental Life, Accidental Death and Dismemberment, and pre-retirement death.

PDF
Affordable Care Act

No forms or guides are associated with the topic “Patient Protection and Affordable Care Act.” However, more information on PPACA is available on the Affordable Care Act page.  You may also read several FAQs related to the PPACA.

Other
COBRA participant information

Some COBRA information in outlined in the Benefits Guide for COBRA Participants, however, most information is provided on the COBRA Participant Information webpage.

Other
Diabetes

No forms or guides are associated with the topic “diabetes.” However, the coverage for diabetes page offers information on obtaining diabetic supplies under your medical insurance plan or your prescription drug plan.

Other
Military leave

No forms or guides are associated with the topic “military leave”. However, you will find more information on options for university benefits available during a military leave of absence on the military page.  

Other
403(b) Tax deferred annuity plan irrevocable one-time election agreement

Form to designate employee contributions to the university’s 403(b) supplemental retirement plan.

PDF
Benefits Change Form for calendar year 2017

Use this form to change your insurance elections due to a family status change for the 2017 calendar year. This form cannot be used during the period of Annual Enrollment.

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Benefits Enrollment Form for calendar year 2017

Benefits Enrollment Form to be used for initial benefit enrollment by new employees or by employees newly eligible for insurance. Must be received within 31 days of eligibility. This form cannot be used during Annual Enrollment.

PDF
Employee Contribution Agreement (for 401(a))

Form to designate employee contributions to the university’s 401(a) Supplemental Retirement Plan.

PDF
Flexible spending account (FSA) enrollment change form for 2017

Flexible Spending Account (FSA) enrollment/change form for the 2017 calendar year.

PDF
Health Savings Account (HSA) Enrollment/Change Form for calendar year 2017

This form is necessary for enrolling in a health savings account (HSA) for this first time, or to make a change to an existing HSA. It applies to calendar year 2017.

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Notice of Intent to Retire (NOI) form

Use this form to officially announce your plans to retire from the university. Submit this form to your department in time to allow the information to reach the University of Missouri System Retirement Program at least 90 days prior to your retirement date.

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Retiree beneficiary designation form

Form for retirees to designate beneficiaries for basic life, supplemental life, and accidental death and dismemberment plans. Cannot be used during retirees’ Annual Enrollment period.

Note: This retiree beneficiary designation form is available on pg. 3 of a combo pack of forms.

PDF
Retiree Benefits Change Form and Retiree Beneficiary Designation Information (combo pack of forms)

Combo pack of forms, including: (1) Retiree benefits enrollment/change form to be used to change insurance elections. (2) Beneficiary designations form for basic life, supplemental life, and accidental death and dismemberment plans. Cannot be used during retirees’ Annual Enrollment period.

Note: The retiree beneficiary designation form is available on pg. 3.

PDF
Supplemental Life- Enrollment and change form (Group Life Insurance Evidence of Insurability)

Use this form to enroll in the university’s supplemental life insurance plan, and also provide evidence of insurability, which is required for the plan.

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Direct Deposit for Retirees—Form 32B: Authorization and Order for Payroll Check Direct Deposit

The direct deposit form is located on the HR Forms webpage. Locate it in the list by the name (Direct Deposit) or the form number (32B).

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Retiree Change of Address Form

Retirees may use this form to change their mailing address with the University of Missouri System retirement office.

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Evidence of insurability—Group Life, Spouse Life, Child Life

Form to confirm evidence of insurability for group life/dependent life insurance.

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Medical claim form for active employees (UHC)

Instructions on accessing the medical claim form for active employees under university medical insurance plans. UnitedHealthcare is the administrator.

Other
Proof of relationship requirement

Proof of relationship requirements to confirm the individual or individuals to be covered are eligible under the specific definitions of the plans.

PDF
Statement of Health Form - Evidence of Insurability - Long Term Disability

Form from MetLife to increase Long Term Disability insurance to Option B.

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University of Missouri Affirmation of Sponsored Adult Dependent Partnership

Form for establishing a sponsored adult dependent relationship for the purpose of university benefits

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Dental claim form

Claim form for the university Dental Plan.

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Flexible spending account (FSA) claim form

Claim form for flexible spending accounts (FSA).

PDF
Medical claim form for retirees (Coventry) for 2016

Medical claim form for retirees under university medical insurance plans for calendar year 2016. Coventry is the administrator.

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Medicare Part D prescription drug claims form

Express Scripts Medicare Part D prescription claims form.

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Prescription drug claims form

Express Scripts prescription claims form.

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Prescription drug mail-in form

Express Scripts prescription drug mail-in order form.

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VSP Out-Of-Network Reimbursement Form

Form for reimbursing expenses incurred at out-of-network providers

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Beneficiary Designation form - Supplemental life insurance

Designate beneficiaries for the university’s supplemental life insurance plan.

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University of Missouri Deferred Vested Benefits - Designation of Beneficiary for Death Benefit

Designate beneficiaries for the Retirement, Disability and Death (RDD) Benefit Plan’s Deferred Vested Benefit.

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University of Missouri Deferred Vested Benefits - Designation of Beneficiary for Guaranteed Period

Designate beneficiaries for the Retirement, Disability and Death (RDD) Benefit Plan’s Guaranteed Period Option.

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University of Missouri Retirement Benefits - Designation of Beneficiary for Guaranteed Period

Designate beneficiaries for retirement benefits under the Retirement, Disability and Death (RDD) Benefit Plan’s Guaranteed Period Option.

PDF
Health Savings Account (HSA) Closure Form

This form is for individuals who are currently enrolled in an HSA through the Healthy Savings Plan, a qualified high-deductible plan. Completion of this form will cancel your enrollment.

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Optional Term Life Insurance Change Request (supplemental life)

Use this form to cancel your supplemental life insurance plan

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