UW Oshkosh Human Resources
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For Supervisors

Benefit Applications On-Line

 
     
   

New Health Insurance Form

Health Insurance Application/Change Form and Instructions
All enrollees use the same form for transactions. Changes and enrollment information are collected on the same form.

 

Dental Insurance (Anthem DentalBlue)

   

 

  

Wisconsin Retirement System

   

Life Insurance Applications
Individual and Family Group Life Insurance

   Election to Participate in Variable
Trust Fund
Beneficiary Designation Form
    State Group Life Insurance    
    UW Employees Life Insurance  

Family Medical Leave
Request Form

   

University Insurance Association (Automatic for Unclassified Staff)

  Physician's Certification
    Accidental Death and Dismemberment Insurance   Catastrophic Leave
        Classified Staff
   

Tax Sheltered Annuity Program

  Classified Staff Application
 

Salary Reduction Agreement Form

 

Classified Staff Donor Form
   


Income Continuation Insurance

 

Unclassified Staff
Faculty and Academic Staff Application
Faculty and Academic Staff Donor Form

    Spectera Vision Insurance    
         
    EPIC Dental & Excess Medical Insurance    
         
    Employee Reimbursement Account (ERA)    
    ERA Enrollment Form    
    Other ERA Forms and Brochures    

 

 

Click here for Benefit Brochures
Click here for Benefit Fair Information
Click here for Dual Choice Open Enrollment
Click here for the It's Your Choice Book

 

= Adobe Acrobat Document
= Microsoft Word Document

After printing & filling out forms, please return them to:
Human Resources, Dempsey 328
 

Questions about the website? Contact Becky Beahm at beahm@uwosh.edu

Go to the main UW Oshkosh site