University of Wisconsin–Madison

Forms

Form Category Subcategory Link
Accidental Death & Dismemberment Application Benefits Accidental Death and Dismemberment Insurance
Accidental Death & Dismemberment - Beneficiary Designation Benefits Accidental Death and Dismemberment Insurance
Delta Dental Application (2020) Benefits Delta Dental
Flexible Spending Account Application (2019) Benefits Flexible Spending Accounts
Flexible Spending Account - Change of Election Form (2019) Benefits Flexible Spending Accounts
Flexible Spending Account - Reimbursement Claim Form Benefits Flexible Spending Accounts
Flexible Spending Account Application (2020) Benefits Flexible Spending Accounts
Flexible Spending Account - Change of Election Form (2020) Benefits Flexible Spending Accounts
Employee Reimbursement Account Claim Form Benefits Flexible Spending Accounts
Dependent Day Care Account Claim Form and Provider Certification Benefits Flexible Spending Accounts
Health Savings Account - Beneficiary Designation Benefits Health Savings Account
Health Savings Account - Distribution Request Form Benefits Health Savings Account
Health Savings Account Claim Form Benefits Health Savings Account
HSA Beneficiary Designation Benefits Health Savings Account
Deductible Met Form Benefits Health Savings Account
Income Continuation Insurance Application Benefits Income Continuation Insurance
Income Continuation Insurance - Evidence of Insurability Benefits Income Continuation Insurance
Individual & Family Group Term Life Application Benefits Individual and Family Group Life Insurance
Individual & Family Group Term Life - Evidence of Insurability Benefits Individual and Family Group Life Insurance
Individual & Family Group Term Life - Beneficiary Designation Benefits Individual and Family Group Life Insurance
Individual & Family Group Term Life - Conversion Application Benefits Individual and Family Group Life Insurance
Individual & Family Group Term Life - Accelerated Benefit Claim Form Benefits Individual and Family Group Life Insurance
State Group Health Application Benefits State Group Health Insurance
Affidavit for Insurance Purposes Benefits State Group Health Insurance
Prescription Drug Claim Form Benefits State Group Health Insurance
FDA Medwatch Forms Benefits State Group Health Insurance
Serve You DirectRx Pharmacy Mail Order Benefits State Group Health Insurance
Eligibility for Standard Tier 2 Premiums Benefits State Group Health Insurance
State Group Life Application Benefits State Group Life Insurance
State Group Life - Evidence of Insurability Benefits State Group Life Insurance
State Group Life - Beneficiary Designation Benefits State Group Life Insurance
State Group Life - Alternate Beneficiary Designation Benefits State Group Life Insurance
State Group Life - Conversion Application Benefits State Group Life Insurance
Fidelity Application Benefits Tax Sheltered Annuity 403(b)
Salary Reduction Agreement Benefits Tax Sheltered Annuity 403(b)
T.Rowe Price Application Benefits Tax Sheltered Annuity 403(b)
TIAA Application Benefits Tax Sheltered Annuity 403(b)
Tax Sheltered Annuity EZ Form Benefits Tax Sheltered Annuity 403(b)
University Insurance Association Life - Beneficiary Designation Benefits University Insurance Association Life Insurance
University Insurance Association Life - Conversion Application Benefits University Insurance Association Life Insurance
University Insurance Association Life - Accelerated Benefit Claim Form Benefits University Insurance Association Life Insurance
UW Employees, Inc. Life Application Benefits UW Employees Inc. Life Insurance
UW Employees, Inc. Life - Evidence of Insurability Benefits UW Employees Inc. Life Insurance
UW Employees, Inc. Life - Beneficiary Designation Benefits UW Employees Inc. Life Insurance
UW Employees, Inc. Life - Conversion Application Benefits UW Employees Inc. Life Insurance
UW Employees, Inc. Life - Accelerated Benefit Claim Form Benefits UW Employees Inc. Life Insurance
VSP Vision Application Benefits VSP Vision Insurance
Wisconsin Deferred Compensation - Complete Application Benefits Wisconsin Deferred Compensation 457(b)
Wisconsin Deferred Compensation - Simplified Application Benefits Wisconsin Deferred Compensation 457(b)
Wisconsin Deferred Compensation - Beneficiary Designation Benefits Wisconsin Deferred Compensation 457(b)
Wisconsin Deferred Compensation - Catch Up Form Benefits Wisconsin Deferred Compensation 457(b)
Wisconsin Deferred Compensation - Transfer/Rollover Form Benefits Wisconsin Deferred Compensation 457(b)
Wisconsin Retirement System - Beneficiary Designation ET-2320 Benefits Wisconsin Retirement System
Wisconsin Retirement System - Alternate Beneficiary Designation ET-2321 Benefits Wisconsin Retirement System
Wisconsin Retirement System - Benefit Information Request Benefits Wisconsin Retirement System
Wisconsin Retirement System - Additional Contribution Election Benefits Wisconsin Retirement System
Wisconsin Retirement System - Maximum Additional Contribution Worksheet Benefits Wisconsin Retirement System
Accident Plan Application Benefits Accident Insurance
Health Savings Account Application (2020) Benefits Health Savings Account