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New York University
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Benefits Forms
Full-Time Employees
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Part-Time Employees
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Benefits Forms
FAQs
Vendor Links for Benefits
Rights & Policies
Benefits Forms
Medical & Dental Claim Forms
Retiree Medical (UnitedHealthcare) Claim Form
Point-of-Service Plan (UnitedHealthcare) Claim Form
UnitedHealthcare Foreign Providers Claim Form
UnitedHealthcare Dependent Eligibility Beyond Age Limit Due to Disability
Dental (MetLife) Claim Form
Prescription Drugs
Caremark Claim Form
Caremark Mail Service Order Form (Prescription Drug)
Reimbursement Accounts Claim Forms
Dependent Care Spending Account (UnitedHealthcare) Claim Form
Health Care Spending Account (UnitedHealthcare) Claim Form
Domestic Partner Affidavit for FSA Claims
Domestic Partner
Domestic Partner Declaration of Federal Tax Status
Domestic Partnership Statement
Domestic Partnership Termination Form
Life Insurance
Life Insurance Enrollment Form Codes 100, 102, 103
Life Insurance Enrollment Form Codes 104, 106, 107 Non-Union
Life Insurance Enrollment Form Code 107 SGT
Life Insurance Enrollment Form Code 107 PRG
Life Insurance Enrollment Form Code 107 Local 810
Life Insurance Medical History Statement for NY Residents
Life Insurance - Application for Conversion of Group Insurance
Absolute Assignment of Life Insurance
Life Insurance Claim Form for Beneficiary Benefits
Retirement Plans
Retirement Plan Enrollment and Investment Selection
TIAA-CREF Designation of Beneficiary Form - for NYU Retirement Plans
TIAA-CREF Retirement Annuities & Suppl. Retirement Annuities Enrollment Form
TIAA-CREF Supplemental Retirement Annuities Enrollment Form
Vanguard Asset Transfer Authorization
Vanguard Designation of Beneficiary Form
Vanguard Distribution Request/Direct Rollover
Vanguard Enrollment/Change Form
Vanguard In-Service Withdrawal Request
STDA Salary Reduction Agreement and Investment Selection Form
457(b) Salary Deferral Agreement and Investment Selection Form
Investment Allocation Form for Adjunct Faculty Retirement Plan
Tuition Assistance
Adjusted Work Schedule for Classes
Graduate Student Assistantships Tuition Award Application
Local 3882 Tuition Reimbursement 20%
Portable Tuition for Dependants - Current Employee
Portable Tuition for Dependants - Retiree and Former Employee
Tuition Remission - Retiree and Former Full Time NYU Employees
Tuition Remission 100% for Job Related Non-Credit SCPS Courses
Tuition Remission Application for Non-Credit SCPS Courses
Tuition Remission - Statement of Job Relatedness for Employee Graduate Courses
Disability & Family Leave
FMLA - Request Family and Medical Leave through Unum
Notice and Proof of Claim for Disability Benefits (DB450)
Other Benefits
Mortgage Origination Fee Reimbursement - Code 100
Mortgage Origination Fee Reimbursement - Code 102
