HIPAA Notice of Privacy Practices

Summary Plan Descriptions
Summary Plan Descriptions (Faculty and Staff)
Summary Plan Descriptions (UMMG)

2008 Benefits Enrollment
myUM
Qualifying Status Change ("Life Event") Form (must be completed in addition to enrollment forms when making any changes to your current medical/dental/flex plan)
Benefits Enrollment Form (faculty/staff)
Benefits Enrollment Form (UMMG)
Benefits Enrollment Form (Miller School of Medicine residents)
Dependent Enrollment Form (faculty/staff)
Dependent Enrollment Form (UMMG)
Dependent Enrollment Form (Miller School of Medicine residents)
Flexible Spending Election Form
Flexible Spending Account Estimator Form  (assists in estimating amount to be used)
Short Term Disability Form
Flu Shot Consent Form
Flu Shot Information

Domestic Partnerships
Certification of Domestic Partnership
Termination of Domestic Partnership
Domestic Partnerships Q&A

Beneficiary 
Designation of Beneficiary Form
Employees' Retirement Plan Beneficiary Form
Employees' Retirement Plan Spousal Consent Form

Flexible Spending Accounts
Flexible Spending Reimbursement Form  
Flexible Spending Direct Deposit Form  
Letter of Medical Need   

Health Care
Instructions on Filing a Claim
Humana Claim Form
Transition of Care (Humana) Form

Mail Order Prescription Drug Forms
RightSource Registration and Prescription Order Form
RightSource Provider Fax Form  (This form is intended to be used only by physicians who wish to fax in a new prescription for the member)

Dental
MetLife Dental Claim Form

Retirement Savings Plan
403(b) Salary Reduction Agreement
AIG Retirement Enrollment Form (please contact Bradley Baumgartner at 305-817-2250)
Fidelity Investments Enrollment Form
Lincoln Financial Group Enrollment Form
TIAA-CREF Enrollment Form
T. Rowe Price Enrollment Form

Supplemental Retirement 
403(b) Salary Reduction Agreement

Short Term Disability
Initial Claim Form
Follow-Up Claim Form

Tuition Remission
Graduate Tuition Remission Taxation Estimate
Spouse/Dependent Graduate Tax Estimate

Voluntary Accidental Death and Dismemberment
Voluntary Accidental Death and Dismemberment Application

Voluntary Excess Life Insurance
Statement of Health Form
Enrollment Form

Long Term Care Insurance
Long Term Care Enrollment Form
Evidence of Insurability