Human Resources Development Forms

Medical

• Enrollment/Change Form
• Benefit Comparison
• Drug Formulary
• Annual Notice of Creditable Prescription Drug Coverage
• Concierge
• Aetna Discount Program
• Aetna Member Website Flyer
• Informed Health Line
• Maintenance Medication Flyer
• Medical Insurance Waiver Form
• Individual Authorization for Release of Information
• Uniform Glossary of Health Coverage and Medical Terms
• Marketplace Coverage Options and Your Health Coverage
• POS Benefit Plan
• POS Schedule of Benefits
• POS Schedule of Benefits with HRA
• Deductible Based Plan Schedule of Benefits HRA
• Deductible Based Plan Schedule of Benefits HSA
• High Deductible Plan Schedule of Benefits HRA
• High Deductible Plan Schedule of Benefits HSA
• Summary of Benefits - DBP with HSA
• Summary of Benefits - DBP with HRA
• Summary of Benefits - HDBP with HSA
• Summary of Benefits - HDBP with HRA
• Summary of Benefits - POS
• SBC Cover Letter for Self-Funded Plans
• SBC Subscriber Letter
• Spousal Health Insurance Attestation

Dental

• Dental Enrollment/Change Form
• Benefit Comparison CT
• Benefit Comparison MA
• DMO Summary Plan Description
• PPO Summary Plan Description
• MA DMO Summary Plan Description
• MA PPO Summary Plan Description
• Dental Claim Form
• Schedule of Benefits DMO
• Schedule of Benefits PPO
• Dental Plan Documents DMO
• Dental Plan Documents PPO
• Assistive Technology

Voluntary Vision

• Voluntary Vision Enrollment/Change Form
• Voluntary Vision Brochure
• Voluntary Vision Benefit Summary
• Find a UHC Vision Provider
• Discover myuhcvision.com
• Vision Plan Document

Medical, Dental, and Vision Rates

• Rates for Full-Time Faculty and Staff
• Rates for Part-time Faculty and Staff Over 30 hours
• Rates for Part-Time Faculty and Staff Under 30 hours

Health Saving Account and Flexible Spending Account

Health Savings Account

• Initial Enrollment form for 2021
• HSA Change Form
• Payflex_HSA Flyer
• Payflex HSA Advantage program overview
• HSA Investments Flyer
• Payflex HSA Custodial Agreement
• PayFlex Trustee Transfer Form
• PayFlex_HSA Quick Reference Guide
• PayFlex HSA Aetna Navigator Overview
• PayFlex Video 1: How to file a claim online
• PayFlex Video 2: How to verify a card purchase
• PayFlex Video 3: How to manage your HSA online
• PayFlex Video 4: Navigating your HSA Dashboard
• PayFlex Video 5: Navigating your Health Care FSA dashboard
• Choice POS II Medical Plan- Deductible Based HSA
• Choice POS II High Deductible Health Plan- HSA

Flexible Spending Account 

• FSA Flyer Limits
• FSA Site Overview
• FSA Eligible Expenses
• FSA Enrollment Form

Health Reimbursement Account

• Choice POS II Medical Plan- Deductible Based HRA
• Choice POS II High Deductible Health Plan- HRA

Employment and Hiring Forms

Rosters, Class Codes, and Position Information

• Stipend Roster (excel)
• Termination Roster (excel)
• Roster Flow Chart
• Employee Class Codes
• Staff Personnel Requisition Form
• Position Needs Analysis
• Position Information Questionnaire
• Personnel Action Form

Hiring and PeopleAdmin

• Hiring Packet for Managers
• Applicant Tracking User Guide

New Hire Forms, I-9, Orientation, etc. 

• On Campus Employment Form for International Students
• Voluntary Self-Identification of Disability
• Department Orientation
• Staff/Faculty/Temporary Employee Request for Identification (HawkCard)
• Direct Deposit Authorization Form
• Employee Data Form

Dialogue for Direction

Dialogue for Direction Guides

• Dialogue for Direction Guide
• Preparing for Your Dialogue for Direction Meeting
• Performance Review Preparation
• Setting "SMART" Goals
• Assessing Your Ability to Lead

• 90-Day Review for New Employees, Transfers and Promotions (Exempt and Non-Exempt)
• Dialogue for Direction Form PDF
• Dialogue for Direction_Word

Tuition Remission Forms

• Tuition Remission Form
• Tax Exemption of a Graduate-Level Course

Miscellaneous

• Address Change Form
• Grievance Form
• Donation of Vacation Time Form
• Flexible Work Schedule Proposal
• Adoption Assistance Claim Form
• Voluntary Phased Retirement Application
• Accident Investigation Form
• Worker's Compensation
• Prescription Fill Form
• Direct Deposit Authorization Form
• Qualifying Event Form

Retirement

• Salary Reduction Agreement
• Schedule a Counseling Session
• TIAA Plan Document Summary
• TIAA Hardship Amendment (SMM)
• TIAA Hold on Employer Contributions (SMM)
• 403(b) Retirement Plan Savings Options

Life Insurance

• Basic Life Insurance Designation of Beneficiary Form
• Optional Life Insurance Designation of Beneficiary Form
• Reliance Standard Portability vs Conversion
• Full-time Faculty and Staff Life Insurance Plan Documents
• Part-time Faculty and Staff Life Insurance Plan Documents
• Retiree Life Insurance Plan Documents