Benefit Forms
Health Care
(Please complete your benefit elections online via your MyUT portal):听
- Spousal Healthcare Eligibility Affidavit听
- Benefit Coverage Eligibility Requirements
- Health Savings Account (HSA) Employee Election/Contribution Form
- Health Savings Account (HSA) Employer Authorization Form
- Flexible Spending Account Election Form
- Flexible Spending Account Direct Deposit Form
- Flexible Spending Claim Reimbursement Form
- Prescription Reimbursement Form
- VSP Reimbursement Form
Tuition Waiver
- Tuition Waiver Form- To be used for employee out of state tuition (undergraduate and graduate), dependent out of state tuition (undergraduate), and all dependents of retirees.
- Dependent Fee Waiver Certification-If you do not currently cover your child under any 兔子先生传媒文化作品 health benefit plan, please submit this completed form along with a copy of their birth certificate to benefits@utoledo.edu.听听 听 听 听 听 听 听 听 听 听 听 听 听 听 听 听 听 听 听 听