HR and Benefit Forms

If you would like paper copies of the forms, please stop by Human Resources in Myer Hall.

Open Enrollment - Now Thru November 30th

The open enrollment period for making changes to your medical, dental, vision, and life insurance, and for making flexible spending account elections to be effective January 1, 2017, begins Thursday, November 3 and ends on Wednesday, November 30, 2016.  All benefit eligible employees must complete the online enrollment process by the close of business, Wednesday, November 30.  All changes will become effective January 1, 2017.

All employees are required to complete the 2017 Annual Enrollment on the Empliant website, even if you are NOT making any benefit elections or changes.


2017 Benefits Information

Benefit Plan Highlights

Summary of Benefits and Coverage

Access your Benefits Information Online Anytime!

Click  here  to access, Empliant, our online benefits portal for employees. Once logged in you will have the ability to view your current benefits elections and update personal information related to your benefits.

Important Notices

2016 Benefits Information (effective January 1, 2016)

Forms and Resources

Capital BlueCross website (to access provider directory, member login, etc.)

Capital BlueCross Enrollment/Change Form

CVS Caremark (prescription plan) Booklet

Davis Vision Plan

Delta Dental Enrollment/Change Form

Domestic Partner Benefit Policy

Emergency Contact Information Form

Employee Assistance Program

Ergonomics - Workstation Self-Evaluation Checklist

Family Recreation ID Request

Flexible Spending Account Payment Schedule

Flexible Spending Account Reimbursement Form - Dependent Care

Flexible Spending Account Reimbursement Form - Medical

FMLA Request Form

Liberty Mutual Insurance Flyer

Life Insurance Beneficiary Change Form

Name Badge Requests

Oil Discount Program

Pet Plan Insurance

Reasonable Accommodation Request Form

Reasonable Accommodation Request - Physician's Certificate

Service Leave Policy

Sick Leave Bank Provisions

TIAA-CREF Beneficiary Change Form

TIAA-CREF Defined Contribution Summary Plan Description 


TIAA-CREF - Salary Reduction Form

Tuition Remission / Exchange Forms

Verizon Wireless Employee Discount