Related Forms - Benefits

Visit the VCU Human Resources forms page for a full list of forms (by category). 

Healthcare and wellness forms

Anthem claim

Blue Card Worldwide International claim 

Blue View Vision Out-of-Network claim 

Dependent care Flexible Spending Account (FSA) claim

Employee health documentation request (Word)

Flexible spending worksheet

Flexible spending enrollment

Health benefits enrollment

Health care flexible spending account (FSA) claim

Health insurance program appeal

Physician selection

Prescription drug exception

Weight Watchers reimbursement

Retirement forms

Beneficiary designation 

Deferred Compensation VRS Retirement One Time Deferral (PDF)

Election of retirement plan (PDF)

Employee certification form for purchase of VRS service credit (PDF)

Fidelity investments

ICMA-RC

Optional Retirement Plan Document (PDF)

Optional Retirement Plan (ORP) Election/VRS Substitute (PDF)

Post offer self identification (PDF)

TDA Plan Document (PDF)

TDA automatic enroll opt out (Word)

TIAA

Virginia Retirement System (VRS) forms

VRS beneficiary designation

VRS member benefit profile error report