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Benefit resources

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Enrollment Forms

Claims Forms | Enrollment Forms | Other Forms & Info | Plan Documents

Health - Medical / Dental / Vision
CT & SM Enrollment/Change Form  
CT & SM (Pre-July2009 Hire) Enrollment/Change Form   PDF
MP & Fac Enrollment/Change Form  
YPBA Enrollment/Change Form   PDF
Healthcare Subsidy Form   PDF
Post-Doc Fellow Enrollment/Subsidy Form  

PDF Form

Disabled Dependent  
Benefits Revision Request Form - Qualifying Event  
Flexible Spending Account and Commuter Benefits
2009 FSA Enrollment Form  
Automatic Transfer/Direct Deposit Opt In/Out Form   Acrobat Reader Required
Commuter Benefits Enrollment & Change Form   Acrobat Reader Required
Child Scholarship

Scholarship Appl. - for First Time Student - Details

   Acrobat Reader Required
Scholarship Appl. - for Returning Student   Acrobat Reader Required
Scholarship Appl. - for Adopted/Step Children   Acrobat Reader Required
Life Insurance and LTD - Standard
Medical History Statement  
Portability Form- MP & Faculty  
Portability Form- CT & SM   pdf
Conversion Form  
Supplemental AD&D Application  
Supplemental LTD Payroll Authorization   Acrobat Reader Required
CT & SM Life Insurance Application & Beneficiary Change form   Acrobat Reader Required
Faculty and M&P Life Insurance Application & Beneficiary Change form   Acrobat Reader Required
Retiree Life Insurance Application & Beneficiary Change form   Acrobat Reader Required
Post-Doc Assoc. Life Insurance Application & Beneficiary Change Form   Acrobat Reader Required
Retirement Payroll Reduction Forms
Yale University Tax-Deferred 403(b) Savings Plan  

Yale University Matching Retirement Plan  

Yale University Retirement Account Plan (YURAP)  

457b Deferred Compensation  
Retirement - Vendor Retirement Application Forms
TIAA-CREF - Group Retirement Annuity for Matching & YURAP Plans  
TIAA-CREF - Group Supplemental Retirement Annuity for
Tax Deferred 403(b) Savings Plan		  
TIAA-CREF - 457b Deferred Compensation  
Acrobat Reader Required
Vanguard - 457b Deferred Compensation  
Acrobat Reader Required
Vanguard - 403(b) Enrollment Form  
Acrobat Reader Required
Other
College Savings 529 (CHET) Application  
Web Form
College Savings 529 (CHET) Payroll Authorization  
Acrobat Reader Required

PDF format requires Adobe Acrobat Reader which can be downloaded from www.yale.edu/software.