View or download our most commonly requested forms by subject:
Find forms & plan documents
Enroll in or change benefits
Most benefit plans can only be changed once a year, during the open enrollment period. If you are new to IU or have experienced a qualifying life event, you can make changes within a specified amount of time.
- Submit a Life Event Change online
Make mid-year changes to your medical, dental, flexible spending account, supplemental AD&D, and other due to an IRS-qualifying life event (e.g. marriage, birth of a child).
- Submit an Optional Benefit Change online
Make mid-year changes to your health savings account, supplemental retirement plans, supplemental life insurance, and long-term disability elections, or update your beneficiaries, at any time.
- Direct Deposit Authorization / Termination Form
- Dependent Care Worksheet
- Additional Debit Card Request Form
- WEX Web & Mobile App Login Instructions
See the qualified Life Events changes page about making changes to your plan.
- You can change your HSA enrollment or election amounts online by submitting an Optional Benefit Change
- Or, if necessary, download and complete the HSA Enrollment / Change Form
- Also visit the WEX website for the following forms:
- Additional Debit Card Request Form
- HSA Contribution Form
- HSA Death Beneficiary Change Form
- HSA Death Distribution Request Form
- HSA Direct Deposit Authorization / Termination Form
- HSA Distribution Request Form
- HSA Power of Attorney Form
- HSA Transfer Form
Change beneficiaries by logging in to your WEX account at www.benefit-info.com/iu/.
Basic Life Insurance
- Add or change beneficiaries online by submitting an Optional Benefit Change through the Employee Center (select Benefits) or download and complete the PDF.
Long Term Disability (LTD) Insurance
- LTD Enrollment/Change/Termination Form
- Medical History Statement to provide Evidence of Insurability: English | Spanish
Supplemental Accidental Death & Dismemberment (AD&D)
- Add or change beneficiaries online at the Employee Center (select Benefits) or download and complete the PDF.
Supplemental Life Insurance
- Add or change beneficiaries online at the Employee Center (select Benefits) or download and complete the PDF.
- Supplemental Life Insurance Enrollment / Change / Termination Form
- Medical History Statement to provide Evidence of Insurability: English | Spanish
Supplemental Dependent Life Insurance
Beneficiaries
To add or change beneficiaries contact the company(ies) directly:
- Fidelity Investments
- PERF
- TIAA (legacy accounts only)
Supplemental Retirement Plans
- Salary Deferral Agreements
You can enroll in a supplemental retirement plan or change your contribution amount/type by submitting an Optional Benefit Change (select Benefits)- Or, if necessary, submitting a paper form:
PERF
- See the INPRS web site for PERF forms
IU Replacement Retirement Plan
Eligibility to participate in this plan is limited. Check the plan web page to see if you qualify.
IU Phased Retirement Program for Faculty
- Affidavit of Eligible Spouse/Child Status
This form is to be used in cases where you do not have possession of or access to any document that verifies your marriage or birth relationship to a spouse or dependent. For example: when actual source documents have been destroyed by fire or other disaster. Unless there are extenuating circumstances, the university does not consider documents inaccessible when they are available through public agencies such as the courts or through a state health department. Contact askhr@iu.edu for questions. - Certification of Disabled Dependent Eligibility
Contact askhr@iu.edu for questions or to request the form to certify your child as a disabled dependent.
Claims and reimbursements
Health care
If a health care provider bills you directly instead of submitting a claim, use these forms to notify the vendor (Anthem, CVS Caremark, etc.) and, if necessary, request reimbursement.
Download the CIGNA Dental Claim Form by logging in to Cigna.com and selecting Claims from the main navigation.
Voluntary insurance plans
If you have opted in to one of these insurance policies, use these forms when you need to make a claim.
Personal information and records
Personal profile and records release forms
How to complete or update your personal information and authorize IUHR to release personnel files or disclose personal health information.
Change your primary (legal) or preferred name, home address, IU office phone number, alternate email address, emergency contacts, military status, or ethnic group can be done through One.IU:
Go to Personal Details
- Select the appropriate field to enter your changes.
For some changes you'll need to complete at personal profile form:
- Change Form, Personal Data
Update personal information already on file (legal name, marital status, SSN, etc.) - Personal Profile Form (ED)
Must be completed by the newly hired employee - Personal Profile Form (PS)
For the employee to identify prior work experience, professional education, licenses etc.
For other changes that you are unable to make directly:
- If you are an academic appointee, contact your campus Dean of Faculties or academic affairs office.
- If you are a non-academic employee, contact your campus departmental human resources representative or human resources office.
- If you need to change your IU office address, contact the HRMS eDoc initiator in your department; this is the person who submits new hire and termination documents to Human Resources.
- Change office phone number if you change departments
- Employee Request/Written Authorization for Release of Personnel Files
Give IU Human Resources permission to release your campus HR records or department personnel file to another person.
- HIPAA Authorization Form
Give IU Human Resources permission to discuss or disclose your Personal Health Information (PHI) or information related to your benefits to another person.
Leaves
Forms for the Family and Medical Leave Act (FMLA), military duty leave, parental leave, and other leaves of absence.
- Certification of Qualifying Exigency for Military Family Leave
- Certification for Serious Injury or Illness of Covered Service Member
- FMLA Definition of Serious Health Conditions
- FMLA Form 1 Leave Notice of Designation, Request, & Approval
- Essential and Marginal Job Functions Worksheet (Word doc)
- FMLA Form 2E Medical Certification for EMPLOYEE
- FMLA Form 2F Medical Certification for FAMILY
- FMLA Form 3 Intent to Return and Fitness for Duty/Medical Release
- Medical Recertification Request
- Tracking Sheet
Tuition Benefit & IU High School
The forms you’ll need to apply for the IU Tuition Benefit for yourself, a spouse, or a dependent, as well as the IUHS tuition waiver for IU high school courses.
Issues in the workplace
Forms for employees and supervisors.
- Statement of Facts Supporting Reasonable Cause of Drug or Alcohol Use by Employee
- Employee Authorization and Consent to Submit to Substance Abuse Testing
- Employee Refusal to Submit To Substance Abuse Testing
- Highlights of a Conditional Employment Agreement (contact IUHR directly for assistance)
- Request for Alcohol/Drug Screening form: Contact Mel Lane (primary contact) at mellane@iu.edu or Greg Jeffers at gajeffer@iu.edu for this form. Campus-specific form and procedures are on the Office of Insurance, Loss Control & Claims website.
- Exempt and Non-Exempt Non-Union Staff
- Non-Exempt CWA Staff Employees at Bloomington & Northwest
- Non-Exempt AFSCME Service Employees at Bloomington, Indianapolis & South Bend
- Non-Exempt AFSCME Police Service Employees at Bloomington, East, Indianapolis, Kokomo, Northwest, South Bend and Southeast
- Part-Time Employees
- Service Positions on Bloomington Campus:
Unsafe Working Conditions (Also available as a Word doc)
Classification and compensation
Forms for HR representatives who are determining the status of new or existing positions.
Rewards and recognition
Recognition and reward submission forms for IU employees.
Plan documents
Medical Care
- Anthem PPO HDHP
- Booklet (1/25)
- Summary (1/25)
- Summary of Benefits & Coverage (1/25)
- Anthem PPO $500 Deductible
- Booklet (1/25)
- Summary (1/25)
- Summary of Benefits & Coverage (1/25)
Dental
Prescription Benefit
- Booklet (2024)
Vision Benefit
- Anthem Blue View Vision (Anthem medical plans)
- Summary (2025)
Group Life Insurance Plan
- Booklet (2020)
Long-Term Disability Insurance Plan (LTD Plan)
- Booklet (2020)
Supplemental Life Insurance
- Booklet (2020)
Supplemental AD&D
- Booklet (2024)
Base Retirement Plans
- IU Retirement Plan
- Retirement & Savings Plan
- Plan Document (6/25)
- PERF Member Handbook
Supplemental Retirement Plans
- IU Tax Deferred Account Plan
- IU 457(b) Retirement Plan
Legacy Plans
- IU 18/20 Retirement Plan
- IU Replacement Retirement Plan
- IUSERP
Retirees Under Age 65:
- Anthem U65 Medical Plan Booklet (2025)
- Anthem U65 Medical Plan Summary (2025)
- Anthem U65 Medical Plan Summary of Benefits and Coverage (2025)
- Blue View Vision Summary (2025)
Retirees Age 65 and Over: