University Of Michigan Benefits Office

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Benefits Office

Forms

Enrollment Forms for New Faculty and Staff Members

Forms
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	Enrollment Forms for New Faculty and Staff Members
	Medical Insurance Forms
	Prescription Drug Plan Forms
	Dental Plan Forms
	Vision Plan Forms
	Life Insurance Forms
	Expanded Long-Term Disability Forms
	Flexible Spending Account Forms
	Retirement Savings Plan Forms
	457(b) Forms
	Graduate Student Forms
	Other Qualified Adult Forms
	Same-Sex Domestic Partnership Forms
	Benefits Enrollment/ Change Forms
	COBRA Forms
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Benefits Services
	Benefits Education

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	HR/Payroll Service Center

Enrollment Forms for New Faculty and Staff Members

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.

Enrollment Deadlines

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.

Retirement Savings Plan Forms

Every effort has been made to ensure the accuracy of the benefits information in this site. However, if any provision on the benefits plans is unclear or ambiguous, the Benefits Office reserves the right to interpret the plan and resolve the problem. If any inconsistency exists between this site and the written plans or contracts, the actual provisions of each benefit plan will govern. The University in its sole discretion may modify, amend, or terminate the benefits provided with respect to any individual receiving benefits, including active employees, retirees, and their spouses, partners, and dependents.