Forms and Plan Documents

Most of the documents on this page are PDFs. Many of the forms can be completed and submitted electronically. To do so download the PDF to your computer and open in Adobe Reader.

Forms

Affidavits and Certifications

Beneficiaries

Insurance Plans
Add or change beneficiaries for IU Basic Life Insurance, Supplemental Life Insurance, and/or Supplemental AD&D:

Retirement Plans
To change the beneficiaries on your IU retirement plan account(s) contact the company directly.

Health Savings Account (HSA)
Change the beneficiaries on your HSA at Nyhart IU Online Services.

Drug Testing

Employment

Temporary Positions Employment Applications

Grievance & Staff Reports

Grievance

Staff Report (Bloomington)

Health (Medical, Dental, Prescription, & Vision)

Dental

Medical

Prescription

Leaves (FMLA, Military, Parental, etc.)

Leave for Development of Commercial Projects with a Non-University Entity

FMLA (Family and Medical Leave Act)

Leave of Absence

Military Leaves

Paid Parental Leave

Life, Disability, & Accident Insurance

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)

Supplemental Life Insurance

Personal Information & Life Events

Life Events Changes

Personal Profile Forms

Retirement Plans

PERF

Salary Deferral Agreements
Enroll in a supplemental retirement plan or change your contribution amount/type by submitting an Optional Benefit Change through the Employee Center (select Benefits), or by submitting a paper form:

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

Salary, Classification, Rewards & Recognition

Spending & Savings (HSA & TSB)

Health Savings Account (HSA)

Tax Saver Benefit (TSB) Plan

See the qualified Life Events changes page about making changes to your plan

Student Health Insurance

See the Student Health Insurance web pages for forms specific to each plan

Tuition Benefit & IU High School

Unsafe Working Conditions

Plan Documents

Employee Assistance Program

Health (Medical, Dental, Prescription, and Vision)

Dental

Medical Care

Prescription Benefit

Vision Wear Benefit

  • Anthem Blue View Vision (Anthem medical plans)
  • Anthem Blue View Vision (IU Blue Retiree members)
  • EyeMed Vision Plan (IU Health medical plan)

Life, Disability, & Accident Insurance

Group Life Insurance Plan

Long-Term Disability Insurance Plan (LTD Plan)

Supplemental Life Insurance

Supplemental AD&D

Retirement Plans

Base Retirement Plans

Supplemental Retirement Plans

  • IU Tax Deferred Account Plan
  • IU 457(b) Retirement Plan

Legacy Plans

Spending & Savings Accounts

Health Savings Account (HSA)

IU Tax Saver Benefit Plan (TSB Plan)

Tuition Benefit

IU Tuition Benefit Plan