IMPORTANT: All of the forms listed on these pages are in Adobe Portable Document Format (PDF). If you do not already have Adobe Acrobat Reader on your computer, you must download and install Adobe Acrobat Reader before you will be able to view or print Benefits forms.

Please Note: You have 30 days from a qualified family status change (marriage, divorce, birth, adoption, etc.) to complete and submit the Benefits Enrollment Change Form. If you do not contact the Benefits Office within this time period, you must wait until the next available Open Enrollment period to make changes to your benefits coverage. Note: U-M benefits for same-sex domestic partners (SSDP) concluded at the end of 2007 to comply with the current Michigan Court of Appeals ruling on same-sex partner benefits. Accordingly, references to U-M recognized Same-Sex Domestic Partnerships in all University policies and documents (other than existing collective bargaining agreements) have been rendered invalid.

• Benefits Enrollment/Change Form

• Moving Out of a Managed Care Service Area

• Declaration of Marriage or Same-Sex Domestic Partnership

• Declaration of Marriage or Same-Sex Domestic Partnership for GEO Members

• Dependent Information Form
  Use this form to update information for your eligible dependents already on record with the University. If you need to add eligible dependents to your benefits, please contact the HR/Payroll Service Center.

• Group Health Insurance Application for Special Enrollment (HIPAA Special Enrollment)

• Notice of COBRA Qualifying Event

• Disabled Dependent Certification


• Stepchild Dependency Agreement



• Application for Principally Supported Child and Employee Certification



• Declaration of Tax Dependency for Same-Sex Domestic Partner and/or Same-Sex Domestic Partner's Child



• Health Care FSA Request for Change in Status



• Dependent Care FSA Request for Change in Status