Benefits Forms

Health Insurance

• Aetna Medical Claim Form
• Vision Claim Form

Dental Insurance

• Dental Claim Form

Flexible Spending Accounts

• https://fba.wealthcareportal.com/Page/PublicDocuments

Life Insurance

• Evidence of Insurability Form
• Group Life Conversion Privilege Form

Supplemental Life Insurance

• Evidence of Insurability Form
• Group Term Life Insurance Portability Election Form
• Group Life Conversion Privilege Form

Time Off, Leaves and Disability

• FMLA Request
• Parental Leave Notification

Work/Life

• Dual Career Intake
• Faculty Meeting Dependent Care Reimbursement 
• Emergency Dependent Backup Care Reimbursement

Domestic Partner Benefits

• Declaration of Domestic Partnership
• Declaration of Tax Dependent Status
• Declaration of Termination of Domestic Partnership