Maine's Public Universities - University of Maine System

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Forms

 

Dental Insurance

CIGNA Dental Claim Form

Domestic Partner

Affidavit of Domestic Partnership

Flexible Spending Account

Flexible Spending Account Claim Form

EBPA Additional FSA Benefits Card Request Form

Health Insurance

Authorization for the Use and/or Disclosure of Protected Health Information

Life Insurance

Beneficiary Designation Form

Evidence of Insurability Form

Medical Leave

Request for Family Medical Leave

Certification of Ability to Return to Work

USDOL Certification of Health Care Provider

Retirement Savings

Salary Reduction Agreement for Salaried Employees

Salary Reduction Agreement for Hourly-Paid Employees

Tuition Waiver

Request Employee Tuition Waiver

Request Dependent Tuition Waiver

Vision

CIGNA Vision Claim Form

 

 

Contact Benefits

If you have a question about your benefits coverage, benefit deduction amounts or any other benefit related question, contact your Campus Benefits Office.  Be prepared to give your Employee ID number.

 

Last Updated:  June 15, 2008