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Benefit resources

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Enrollment Forms

Claims Forms | Enrollment Forms | Other Forms & Info | Plan Documents

Health - Medical / Dental/Vision
CT & SM Enrollment/Change Form  
MP & Fac Enrollment/Change Form  
Post-Doc Fellow Enrollment/Subsidy Form  

PDF Form

Disabled Dependent
Benefits Revision Request Form - Qualifying Event  
Flexible Spending Account and Commuter Benefits
2008 FSA Enrollment Form  
Automatic Transfer/Direct Deposit Opt In/Out Form   Acrobat Reader Required
Commuter Benefits Enrollment & Change Form Word Document Acrobat Reader Required
Child Scholarship

Scholarship Appl. - for First Time Student- Details

   Acrobat Reader Required
Scholarship Appl. - for Returning Student   Acrobat Reader Required
Scholarship Appl. - for Adopted/Step Children   Acrobat Reader Required
Life Insurance and LTD - Standard
Medical History Statement  
Portability Form- MP & Faculty  
Portability Form- CT & SM   pdf
Conversion Form  
Supplemental AD&D Application  
Supplemental LTD Payroll Authorization   Acrobat Reader Required
CT & SM Life Insurance Application & Beneficiary Change form   Acrobat Reader Required
Faculty and M&P Life Insurance Application & Beneficiary Change form   Acrobat Reader Required
Retiree Life Insurance Application & Beneficiary Change form   Acrobat Reader Required
Post-Doc Assoc. Life Insurance Application & Beneficiary Change Form   Acrobat Reader Required
Retirement Payroll Reduction Forms
Automatic Enrollment in YURAP Waiver (Faculty only)   pdf
Supplemental Retirement Account (SRA)

Word

Matching Retirement Plan for C&T/S&M Employees

YURAP - Election Form (M&P/Fac)
457b Deferred Compensation
Retirement - Vendor Retirement Application Forms
TIAA-CREF - Retirement Annuity (M&P/Fac)  
TIAA-CREF - Matching Retirement Application (C&T/S&M)  
TIAA-CREF - Group Supplemental Retirement Annuity  
TIAA-CREF - 457b Deferred Compensation  
Acrobat Reader Required
Vanguard - 457b Deferred Compensation  
Acrobat Reader Required
Vanguard - 403b Enrollment Form  
Acrobat Reader Required
Other
College Savings 529 (CHET) Application  
Web Form
College Savings 529 (CHET) Payroll Authorization  
Acrobat Reader Required

PDF format requires Adobe Acrobat Reader which can be downloaded from www.yale.edu/software.