University of Wisconsin–Madison

Forms

Form Category Subcategory Link
Accident Plan AD&D Beneficiary Form Benefits Accident Plan
Accident Plan Application Benefits Accident Insurance
Accidental Death & Dismemberment - Beneficiary Designation Benefits Accidental Death and Dismemberment Insurance
Accidental Death & Dismemberment Application Benefits Accidental Death and Dismemberment Insurance
Affidavit for Insurance Purposes Benefits State Group Health Insurance
Affidavit of Domestic Partnership Benefits Individual and Family Group Life Insurance
Deductible Met Form Benefits Health Savings Account
Delta Dental Application Benefits Delta Dental
DeltaVision Enrollment Form Benefits DeltaVision
Dependent Day Care Account Claim Form and Provider Certification Benefits Flexible Spending Accounts
Eligibility for Standard Tier 2 Premiums Benefits State Group Health Insurance
Employee Reimbursement Accounts Enrollment Form Benefits Employee Reimbursement Accounts
FDA Medwatch Forms Benefits State Group Health Insurance
Fidelity Application Benefits 403(b) Supplemental Retirement Program
Flexible Spending Account Application Benefits Flexible Spending Accounts
Flexible Spending Account - Change of Election Form Benefits Flexible Spending Accounts
Flexible Spending Account Claim Form Benefits Flexible Spending Accounts
Health Savings Account - Change of Election Form Benefits Health Savings Account
Health Savings Account Application Benefits Health Savings Account
Health Savings Account Claim Form Benefits Health Savings Account
HSA Beneficiary Designation Benefits Health Savings Account
Income Continuation Insurance - Evidence of Insurability Benefits Income Continuation Insurance
Income Continuation Insurance Application Benefits Income Continuation Insurance
Individual & Family Group Term Life - Accelerated Benefit Claim Form 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 - Evidence of Insurability Benefits Individual and Family Group Life Insurance
Individual & Family Group Term Life Application Benefits Individual and Family Group Life Insurance
Prescription Drug Claim Form Benefits State Group Health Insurance
Salary Reduction Agreement Benefits 403(b) Supplemental Retirement Program
Serve You DirectRx Pharmacy Mail Order Benefits State Group Health Insurance
Sick Leave Restoration Request Benefits Wisconsin Retirement System
State Group Health Application - 2024 Benefits State Group Health Insurance
State Group Life - Alternate Beneficiary Designation Benefits State Group Life Insurance
State Group Life - Beneficiary Designation Benefits State Group Life Insurance
State Group Life - Conversion Application Benefits State Group Life Insurance
State Group Life - Evidence of Insurability Benefits State Group Life Insurance
State Group Life Application Benefits State Group Life Insurance
Tax Sheltered Annuity EZ Form Benefits 403(b) Supplemental Retirement Program
TIAA Application Benefits 403(b) Supplemental Retirement Program
University Insurance Association Life - Accelerated Benefit Claim Form Benefits University Insurance Association Life Insurance
University Insurance Association Life - Beneficiary Designation Benefits University Insurance Association Life Insurance
University Insurance Association Life - Conversion Application Benefits University Insurance Association Life Insurance
UW Employees, Inc. Life - Accelerated Benefit Claim Form 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
Wisconsin Deferred Compensation - Beneficiary Designation Benefits Wisconsin Deferred Compensation 457(b)
Wisconsin Retirement System - Additional Contribution Election Benefits Wisconsin Retirement System
Wisconsin Retirement System - Alternate Beneficiary Designation ET-2321 Benefits Wisconsin Retirement System
Wisconsin Retirement System - Beneficiary Designation ET-2320 Benefits Wisconsin Retirement System
Wisconsin Retirement System - Benefit Information Request Benefits Wisconsin Retirement System
Wisconsin Retirement System - Maximum Additional Contribution Worksheet Benefits Wisconsin Retirement System
Employee Trust Funds Address/Name/Gender Change Form Benefits Wisconsin Retirement System

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