暗网禁区

Benefit Forms

Health Care

(Please complete your benefit elections online via your MyUT portal):听

• Spousal Healthcare Eligibility Affidavit听
• Benefit Coverage Eligibility Requirements
• Health Savings Account (HSA) Employee Election/Contribution Form
• Health Savings Account (HSA) Employer Authorization Form
• Flexible Spending Account Election Form
• Flexible Spending Account Direct Deposit Form
• Flexible Spending Claim Reimbursement Form
• Prescription Reimbursement Form
• VSP Reimbursement Form

Tuition Waiver

• Tuition Waiver Form- To be used for employee out of state tuition (undergraduate and graduate), dependent out of state tuition (undergraduate), and all dependents of retirees.
• Dependent Fee Waiver Certification-If you do not currently cover your child under any 暗网禁区 health benefit plan, please submit this completed form along with a copy of their birth certificate to benefits@utoledo.edu.听听 听 听 听 听 听 听 听 听 听 听 听 听 听 听 听 听 听 听 听

Life Insurance

• Main Campus Life Enrollment听 听 听 听
• Health Science Life Enrollment Form
• Beneficiary Designation Form