All printable forms are in Adobe Acrobat format, unless indicated otherwise.
Health, Dental and Vision Insurance
State Employees Group Insurance Plans:
Enrollment and changes are completed at MyBenefits.
University of Illinois Termination of Domestic Partnership
Insurance Leave Information
See Leave Forms.
Flexible Spending Accounts (FSA)
Enrollment and changes are completed at MyBenefits.
MCAP Continuation Election Form
Life Insurance
State Employees Group Insurance Plans:
Enrollment and changes are completed at MyBenefits.
To review or update your beneficiary online login to your account at https://www.metlife.com/stateofillinois/.
See State Life Insurance for login instructions.
You may also designate beneficiaries using the Beneficiary Designation form.
Statement of Health Form (also known as Evidence of Insurability)
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
State Employees Group Insurance Plans:
Enrollment and changes are completed at MyBenefits.
The Hartford (University Plan)
Online Enrollment
Beneficiary Designation Instructions and Form - submit your completed form to Univeristy Payroll & Benefits
Claim Form
Retirement Plans
State Universities Retirement System (SURS)
Update your beneficiaries online.
University Supplemental 403(b) Retirement Plan
Online Salary Reduction and/or Redirection Agreement (SRA) - To make, change, or stop your plan contribution. A paper SRA form may be used if you are unable to access the online form.
Fidelity Online Beneficiary Designation/Changes. If you are unable to access the online form, call Fidelity at 800-343-0860 to request a paper form.
Fidelity Transfer/Rollover/Exchange Form or begin the process online in NetBenefits.
TIAA Online Beneficiary Designation/Changes. A paper form may be used if you are unable to access the online form.
TIAA Transfer/Rollover Form
State 457 Deferred Compensation Program
Go to T. Rowe Price to enroll, make changes, and add/update beneficiaries.
Catch-up Application
Lump Sum Deferral Form
Permissive Service Credit Authorization Form
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.