Related Forms - Benefits

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

Healthcare and wellness forms

Anthem claim

Aetna claim

Blue Card Blue Shield Global Core International claim 

Blue View Vision Out-of-Network claim 

Delta Dental claim

Employee health documentation request (Word)

Flexible Spending Account (FSA) claim form (health care & dependent care)

Health benefits and flexible spending enrollment

Health benefits and flexible spending enrollment (DocuSign version)

Health insurance program appeal

Physician selection

Prescription drug exception

Retirement forms

Beneficiary designation 

Deferred Compensation VRS Retirement One Time Deferral (PDF)

Election of retirement plan (PDF)

Election of retirement plan (DocuSign version)

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

Fidelity investments

ICMA-RC

Optional Retirement Plan Document (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