Health Insurance Application/Change Form
Changes and enrollment information are collected on the same form.

Application/Change Form
Affidavit of Domestic Partnership

Imputed Income Tables -- Fair Market Value of health insurance for Non-Tax Dependents

Imputed Income Tax Calculator for domestic partners and adult children between the ages
of 19 and 27

Dental (HMO, PPO & Supplemental) Insurance
Anthem DentalBlue

Supplemental Health & Dental Insurance
EPIC Dental & Excess Medical Insurance

Wisconsin Retirement System
Election to Participate in Variable
Trust Fund
Beneficiary Designation Form

Tax Sheltered Annuity Program (403b)
Salary Reduction Agreement Form

Wisconsin Deferred Compensation Program (457)
Enrollment Form

Employment Reimbursement Account
ERA Enrollment Form
Other ERA Forms and Brochures

Long-Term Care Insurance
Senior Care and HealthChoice

Vision Insurance
For 2009 Only: OptumHealth Vision
Effective 2010: VSP Vision Care

Disability Insurance
Income Continuation Insurance (ICI)

Life Insurance Applications
Individual & Family Group Life Insurance
State Group Life Insurance
UW Employees, Inc. Life Insurance
University Insurance Association
... (Automatic for Unclassified Staff)
Accidental Death & Dismemberment Insurance

Family/Medical Leave (FMLA)
Request Form
Physician's Certification

Catastrophic Leave
Classified Staff
Classified Staff Application
Classified Staff Donor Form
Unclassified Staff
Faculty and Academic Staff Application
Faculty and Academic Staff
Donor Form