Benefits Forms
Medical, Dental & Vision
- Point-of-Service Plan (UnitedHealthcare) Claim Form (PDF)
- UnitedHealthcare Foreign Providers Claim Form (PDF)
- UnitedHealthcare Dependent Eligibility Beyond Age Limit Due to Disability (PDF)
- Dental (MetLife) Claim Form (PDF)
- Dental (MetLife) Reimbursement Direct Deposit Form (PDF)
- VSP Out-of-Network Reimbursement Form
- Social Security Number/Medicare Coordination Form
Flexible Spending Accounts
Domestic Partner
Tuition Assistance
- Adjusted Work Schedule for Classes (PDF)
- Local 1 Tuition Reimbursement 20% (PDF)
- Local 3882 Tuition Reimbursement 20% (PDF)
- Portable Tuition for Dependents - Current Employee (PDF)
- Portable Tuition for Dependents - Retiree and Former Employee (PDF)
- Job Relatedness for Employee Graduate Tuition Remission Tax Form (available in the Tuition Remission System on NYUHome)
- Tuition Remission: Employees and their Spouses, Domestic Partners, and Dependents | Retirees with Active NetID | Retirees without Active NetID (PDF)