Total Rewards forms and guides

An overview of the many of the insurance benefits enrollment process.

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

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

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

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

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

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

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

Use this form to change your insurance elections due to a family status change for the 2019 calendar year. This form cannot be used during the period of Annual Enrollment.

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.

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

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.

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.  

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

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

Enroll or change a Health Care FSA and/or Dependent Care FSA for the 2019 calendar year.

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 2019.

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.

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.

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.

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.

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).

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

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

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

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

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

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

Claim form for the university Dental Plan.

Claim form for flexible spending accounts (FSA).

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

Express Scripts Medicare Part D prescription claims form.

Express Scripts prescription claims form.

Express Scripts prescription drug mail-in order form.

Form for reimbursing qualified vision expenses incurred at out-of-network providers.

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

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

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

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

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.

Use this form to cancel your supplemental life insurance plan

Use this form to terminate a sponsored adult dependent relationship for university benefits

You must complete this form so your employer can withhold the correct amount of Illinois Income Tax from your pay.

NOTE: You will be redirected to the Illinois Revenue website to access this form.

Form used to exercise the option to sell shares of Fidelity Investments Asset Manager 50%, to which an individual may be entitled under the terms and conditions of the University of Missouri Faculty Performance Shares Plan.

This certificate is for voluntary withholding of Missouri State Income Tax from pension or annuity income only.

NOTE: You will be redirected to the Missouri Department of Revenue website to access this form.

Form for authorization of release of personal health information under HIPAA.

Form for formally requesting the university to not withhold Missouri income taxes from pay due to an employee performing services for the university outside of Missouri, or an employe being a retiree residing outside of Missouri.

Form W-4P is for U.S. citizens, resident aliens, or their estates who are recipients of pensions, annuities (including commercial annuities), and certain other deferred compensation. Use Form W-4P to tell payers the correct amount of federal income tax to withhold from your payment(s).

NOTE: You will be redirected to the IRS website to access this form.

Use this form to request an estimate of your retirement or vested benefit estimate

Complete and submit this form in order for the University of Missouri System Retirement Program to review your prior service with the university. To be eligible for any prior service, your previous employment must have been at least one year in length with an FTE of at least 75%.