Payroll Forms & Publications

Medical

• Plan Comparison Information
• Enrollment Guide
• Medical Enrollment/Change Form
• Dependent With Disabilities Certification Form
• Request for an Appeal
• Verification of Dependents
• Authorization for Deduction to Health Savings Account
• Tobacco & Spousal Surcharge Attestation Form
• Tobacco & Spousal Surcharge Help Sheet
• Spousal Plan Calculator

Medical Claim Forms

• Uniform Medical & Vision Claim Form
• Group Health Classic and Value Medical & Vision Claim Form

Prescription Plans

• Uniform Online Pharmacy
• Kaiser WA Online Pharmacy
• Kaiser WA Prescription Claim Form

Life Insurance

Visit MetLife webpage for more information.

Long-Term Disability

• Long-Term Disability Benefit Booklet
• Long-Term Disability Enrollment/Change Form
• Long-Term Disability Evidence of Insurability Form

Flexible Spending

• Forms and Documents

VEBA

• VEBA Plan Information and Enrollment
• VEBA Claim Form
• VEBA Direct Deposit Enrollment Form
• VEBA Election of limited VEBA Plan Coverage Form for those with HSA accounts
• VEBA Automatic Premium Reimbursement Form for retirees
• VEBA Investment Allocation Change Form
• VEBA Account Change Form

IRS Forms

• 2019 W-4 Form
• I-9 Instructions
• I-9 Form

Miscellaneous Forms

• Employee Address Change Form
• Direct Deposit Form
  • US Bank Focus Card Disclosures
• Student Help Payroll Authorization2019-20
• FTEF Calculation Schedule – Mode Values
• Faculty Report of Absence Form