Forms

• 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).
  • Life Event Instructions

• 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.
  • OBC Instructions

• 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

• Supplemental Dependent Life Enrollment / Change / Termination Form

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

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.

• Replacement Retirement Plan Application
• 18/20 Plan Application for Replacement Retirement Plan
• TIAA Direct Deposit Form
• Withholding Certificate for Pension or Annuity Payments - W-4P
• Annuitant’s Request for State Income Tax Withholding - WH-4P

IU Phased Retirement Program for Faculty

• Application and agreement

• 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.

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:

• 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.