All printable forms are in Adobe Acrobat format, unless indicated otherwise.
Health, Dental and Vision Insurance
For State Employees Group Insurance Plans:
Enrollment and changes are completed at CMS MyBenefits.
University of Illinois Termination of Domestic Partnership
Insurance Leave Information
See Leave Forms.
Flexible Spending Accounts (FSA)
Enrollment and changes are completed at CMS MyBenefits.
MCAP Continuation Election Form
Life Insurance
For State Employees Group Insurance Plans:
Enrollment and changes are completed at CMS MyBenefits.
Designate beneficiaries using the Beneficiary Designation form.
Voya Financial (formerly ING/ReliaStar) University Plan
Request for Change - Effective July 1, 2011 no new enrollees are allowed. If you enrolled prior to July 1, 2011 you may request changes.
Request for Change of Beneficiary - Effective July 1, 2011 no new enrollees are allowed. If you enrolled prior to July 1, 2011 you may request changes.
Long Term Disability (LTD) Insurance
Prudential (University Plan)
Online Enrollment
Statement of Health
LTD Conversion Kit
Accidental Death & Dismemberment (AD&D) Insurance
For State Employees Group Insurance Plans:
Enrollment and changes are completed at CMS MyBenefits.
The Hartford (University Plan)
Online Enrollment
Beneficiary Designation Instructions and Form
Claim Form
Retirement Plans
State Universities Retirement System (SURS)
Update your beneficiaries online.
University Supplemental 403(b) Retirement Plan
Salary Reduction and/or Redirection Agreement (SRA) | Online SRA - To be used for an initial election or change to the 403(b) plan.
Fidelity Beneficiary Designation
Fidelity Retirement Plan Transfer/Rollover/Exchange Form
TIAA Beneficiary Designation
TIAA Retirement Plan Transfer/Rollover Form
State 457 Deferred Compensation Program
State 457 Forms - CMS page with enrollment form, change form, and beneficiary form.
Pay Periods and Payroll Codes - To help determine the initial pay period and payroll codes needed for enrollment.
Deferring Vacation/Sick Leave Payouts
OBFS Terminal Benefit Net Pay Calculator - To assist with estimating payouts.
Benefits Payout Deferral Worksheet - To be completed by your department HR contact or business manager.
Tuition Waiver Forms
See
Tuition Waivers for any required forms.