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Employee Handbooks

Office of Human Resources: Employee Benefits Links to forms

 

FORMS

Most forms are in fillable pdf. (What is pdf?)
Search for a specific form by keyword in the Find window: Control-F

Health Insurance

Health Insurance Enrollment Form for Active Employees

     StateActiveEnrollForm

COVA Care Plan

     Anthem Claim Form  http://www.anthem.com/shared/noapplication/f5/s1/t0/pw_m008894.pdf

     Medco Prescription Drug Reimbursement Form

     Medco Prescriptions By Mail Order Form

     Medco FAX Prescriptions Form

COVA Connect Plan

     Optima Forms and Documents

Virginia Retirement System

VRS Beneficiary Designation Form
http://www.varetire.org/Pdf/vrs-2fill.pdf

Application to Purchase Prior Service
http://www.varetire.org/Pdf/vrs-26fill.pdf

Agreement for Salary Reduction to Purchase Service Credit
http://www.varetire.org/Pdf/vrs-26efill.pdf

Authorization for After-Tax Payroll Deduction to Purchase Service Credit
http://www.varetire.org/Pdf/vrs-26cfill.pdf

Request for Review of Membership Records
http://www.varetire.org/Pdf/vrs-70fill.pdf

Request for Estimate of Service Retirement Benefits
http://www.varetire.org/Pdf/vrs-60fill.pdf

Optional Retirement System

Election to Participate - ORP for Higher Education
http://www.varetire.org/Pdf/vrs-65fill.pdf

Termination Certification Form - ORP for Higher Education
http://www.varetire.org/Pdf/vrs-65dfill.pdf

ORP Health Insurance Credit Employer Certification of Service
http://www.varetire.org/Pdf/vrs-75fill.pdf

Basic and Optional Group Life Insurance

Optional Group Life Insurance Enrollment Form
https://web1.lifebenefits.com/lbe/grppdforms/VRS009643/52833.pdf

Evidence of Insurability Form
https://web1.lifebenefits.com/lbe/grppdforms/VRS009643/52749.pdf

Change Form for Optional Group Life Insurance Plan
https://web1.lifebenefits.com/lbe/grppdforms/VRS009643/53411.pdf

VRS Beneficiary Designation Form
http://www.varetire.org/Pdf/vrs-2fill.pdf

Deferred Compensation - 457 Plan

Forms

Tax Sheltered Annuities

Salary Reduction Agreement - 403(b) Plan

Cash Match Agreement

Leave

Administrative and Teaching Faculty Leave Request Form 1-2010

Request for Family and Medical Leave

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