Human Resources | Benefits Forms

Forms


Benefit Forms
	Change of Address
	Examples of Over the Counter Medical Expense Reimbursements through FSA
	Flexible Spending Account Worksheet
	Flexible Spending Reimbursement Request Form
	Reimbursement Account Direct Deposit Authorization - EBDS
	FSA Orthodontia Worksheet
	Life Insurance Change of Beneficiary Form Medical / Maternity Leave Form Medical Claim Form (Highmark) Prescription Drug Reimbursement Form Caremark Mail Service Enrollment Form Caremark Prior Authorization Request Form Port Authority Deduction Authorization Form Qualified Life Event Form
	Retirement Plan Funds
	Retirement Plan Salary Reduction Form
	Tuition Remission Highmark Immunization and Preventive Schedule Customer Service Contact Card
You can also obtain hard copies of these forms by contacting the Benefits Office at 396-5105 or e-mail: benefits@duq.edu Also see The Administrative Policies for more information on these and other subjects.