University Personnel

Benefit Forms

2022 HCRA / DCRA Enrollment Form

Dental Plan Enrollment Form

Acknowledgement & Missed Premium AR Agreement

Additions and Deletions Worksheet

Affidavit of Marriage or Domestic Partnership

Affidavit of Parent-Child Relationship

Anthem Claim Form

CalPERS Beneficiary Designation

Computer Vision Confirmation Form

DCRA / HCRA Reimbursement Form

Declaration of Health Coverage

Dental Claim Form

Domestic Partner Tax Dependent Certification Form

Flexcash Enrollment Form

FSA / ASIFlex debit card request

New Employee Benefits Enrollment Worksheet

The Standard Insurance Co Beneficiary Designation

VSP Vision Premier Enrollment Form

VSP Vision Reimbursement Form