University of Wisconsin–Madison

Forms

wdt_ID Form Category Link
1 State Group Health Application Benefits / Health / Application
2 Affidavit for Insurance Purposes Benefits / Health / Affidavit / Social Security Number
3 Prescription Drug Claim Form Benefits / Health / Prescription / Claim
4 FDA Medwatch Forms Benefits / Health / Prescription
5 Serve You DirectRx Pharmacy Mail Order Benefits / Health / Prescription
6 Delta Dental Application (2019) Benefits / Dental / Supplemental
7 VSP Vision Application Benefits / Vision / Supplemental
8 State Group Life Application Benefits / Life
9 State Group Life - Evidence of Insurability Benefits / Life / EOI / Evidence
10 State Group Life - Beneficiary Designation Benefits / Life / Beneficiary