Benefits forms

 

In most cases, new employees will use the MyBenefits@UGA system to enroll for benefits. Print and read the guide for new employees below.

bullet Get the MyBenefits@UGA guide for new employees

Current employees who need to request changes due to IRS-approved "life events" should print and read the change guide below.

bullet Get the MyBenefits@UGA change guide for current employees

Health insurance

Health expense claim form (for Open Access POS and HSA Open Access POS plans)
Health enrollment form for surviving dependent
Employee request to continue health Coverage (COBRA)
Dependent request to continue health coverage (COBRA)
Request to change COBRA health coverage
Fax cover sheet for dependent enrollment documentation
Tobacco use change form

___

Health change (retirees only during open enrollment)

Health change form (for retirees only)
Tobacco affidavit form
(for retirees only)

Dental insurance

Dental expense claim (for procedures initiated through December 31, 2013 only)
Insurance request for dependent, unmarried students
Dental enrollment form for surviving dependent
Employee request to continue dental coverage (COBRA)
Dependent request to continue dental coverage (COBRA)
Request to change COBRA dental coverage
Fax cover sheet for dependent enrollment documentation

Dental change (retirees only during open enrollment)

Dental change form (for retirees only outside open enrollment)

Accidental death & dismemberment insurance (AD&D)

"Proof of loss" claim statement (email Employee Benefits or call 706-542-2222)

Long term disability insurance

How to file an LTD claim (or illness/injury on or before December 31, 2013 only)

Short term disability insurance

How to file a short term disability claim (for illness/injury on or before December 31, 2013 only)

Vision insurance

Employee request to continue vision coverage (COBRA)

Dependent request to continue vision coverage (COBRA)

Request to change vision COBRA coverage

HSA, FSA, LPFSA

Health Savings Account enroll/change (use the MyBenefits@UGA system; get the HSA guide)
Handle all transactions on the U.S. Bank site

Life insurance

Minnesota Life beneficiary form (for retirees ONLY)

Active employees: access your MyBenefits@UGA account at www.uga.bswift.com to designate or change beneficiaries.

Retirement & retirees

UGA ORP election form*
ORP election form (required by TRS)
ORP change form
*

*(If you enroll or change ORP companies, you must also complete and submit company applications. Company contact information.)

Georgia Defined Contribution Plan (GDCP) reimbursement request form

Bank draft form
(for retirees only)

529 Higher Education Savings Plan

529 payroll deduction form

Georgia 529 banking form

Leave

Leave without pay

Questions about benefits forms may be directed to benefits@uga.edu or 706-542-2222.

 

December 11, 2014