Human Resources

Forms

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Benefits

• Affidavit of Domestic Partnership/Acknowledgment of Domestic Partnership
• Flu Vaccination Consent Form
• Life Beneficiary Designation
• MMO Student Certification
• Meritain Full-Time Student Verification Form

Benelect Forms

• Benelect 2008 Enrollment Form
• Benelect 2008 Change of Status
• 2008 Benelect cost structure for full-time (working 37.5 hr/wk) 100% Nonexempt Price Sheet
• 2008 Benelect cost structure for three-quarter-time (nonexempt working 28-37.4 hr/wk) 75% Nonexempt Price Sheet
• 2008 Benelect cost structure for half-time (nonexempt working 18.75 to 27.9 hr/wk) 50% Nonexempt Price Sheet
• 2008 Benelect cost structure for full-time (exempt working 40 hr/wk) 100% Exempt Price Sheet
• 2008 Benelect cost structure for three-quarter-time (exempt working 30-39.9 hr/wk) 75% Exempt Price Sheet
• 2008 Benelect cost structure for half-time (exempt working 20-29.9 hr/wk) 50% Exempt Price Sheet

Enrollment Forms

• Kaiser Permanente Enrollment Application
• Supplemental Life Extended Employee Application
• Medical Mutual / Supermed Plus Application and Policy Change
• Meritain Enrollment Form for DenteMax, Health, and/or Dependent Care Spending Accounts
• School of Dental Medicine Dental Care Enrollment Application
• Union Eye Care Enrollment Form

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

• AdvancePCS Reimbursement Standard Claim Form >>
• Dental Claim Form >>
• Flex Dependent Care Reimbursement Acct Claim Form >>
• Flex Health Care Reimbursement Acct Claim Form >>
• Medical Mutual of Ohio (MMO) Claim Form

Leave of Absence

• Leave of Absence Form
• Certificate of Health Care Provider
• Certification by a Health Care Provider for Returning to Work
• Case Response to Employee Request for Family or Personal Medical Leave

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