Forms

Enroll in or change benefits

  • You can change your HSA enrollment or election amounts online by submitting an Optional Benefit Change
  • 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

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

Supplemental Dependent Life Insurance

Beneficiaries
To add or change beneficiaries contact the company(ies) directly:

Supplemental Retirement Plans

PERF

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.

Personal information and records

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:

  1. Go to Personal Details

  2. Select the appropriate field to enter your changes.

For some changes you'll need to complete at personal profile form:

For other changes that you are unable to make directly:

  • 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.

Tuition Benefit & IU High School

Issues in the workplace

  • Corrective Action/Counseling Form
    PDF or Word

Classification and compensation

Rewards and recognition

Plan documents

Medical Care

Dental

Prescription Benefit

Vision Benefit

  • Anthem Blue View Vision (Anthem medical plans)

Group Life Insurance Plan

Long-Term Disability Insurance Plan (LTD Plan)

Supplemental Life Insurance

Supplemental AD&D

Base Retirement Plans

Supplemental Retirement Plans

Legacy Plans

IU Tuition Benefit Plan

Retirees Under Age 65:

Retirees Age 65 and Over: