Benefits Forms

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

Leave of Absence Information and Form


Flexible Spending Accounts (FSA)

Enrollment and changes are completed at CMS MyBenefits.


Life Insurance

For State Employees Group Insurance Plans:

Enrollment and changes are completed at CMS MyBenefits.

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


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
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.
Estimated Terminal Benefit Payout Form - To be completed by your department HR contact or business manager.