HIPAA Notice of Privacy Practices

2012 Healthcare
Qualifying Status Change ('Life Event') Form (must be completed in addition to enrollment forms when making any changes to your current medical/dental/flex plan)
Benefits Enrollment Form (Faculty/Staff)
Benefits Enrollment Form (UMMG Physicians)
Benefits Enrollment Form (Miller School of Medicine Residents)
Dependent Enrollment Form (Faculty/Staff)
Dependent Enrollment Form (UMMG Physicians)
Dependent Enrollment Form (Miller School of Medicine Residents)
Nonsmoking Certification
Spouse/Partner No Access Certification
Adult Dependent No Access Certification
Flexible Spending Election Form
Short Term Disability Enrollment Form
Aetna Rx Home Delivery
FSA Healthcare Reimbursement Form
FSA Dependent Reimbursement Form
Aetna Medical Claim Form
Aetna Rx Claim Form
Delta Dental Claim Form
Aetna Precertification Rx Form

2011 Healthcare
Qualifying Status Change ('Life Event') Form (must be completed in addition to enrollment forms when making any changes to your current medical/dental/flex plan)
Benefits Enrollment Form (Faculty/Staff)
Benefits Enrollment Form (UMMG Physicians)
Benefits Enrollment Form (Miller School of Medicine Residents)
Dependent Enrollment Form (Faculty/Staff)
Dependent Enrollment Form (UMMG Physicians)
Dependent Enrollment Form (Miller School of Medicine Residents)
Nonsmoking Certification
Spouse/Partner No Access Certification
Flexible Spending Election Form
Short Term Disability Enrollment Form
Aetna Rx Home Delivery
FSA Healthcare Reimbursement Form
FSA Dependent Reimbursement Form
Aetna Medical Claim Form
Aetna Rx Claim Form
Delta Dental Claim Form
Aetna Precertification Rx Form

Domestic Partnerships
Certification of Domestic Partnership
Termination of Domestic Partnership
Domestic Partnerships Q&A

Beneficiary
Beneficiary designations must be completed at myUM.
Employees' Retirement Plan Spousal Consent Form

Retirement Savings Plan (RSP)
Please click here for steps to enroll.

Supplemental Retirement
Please click here for steps to enroll.

Short Term Disability
Initial Claim Form
Follow-Up Claim Form

Tuition Remission
Graduate Tuition Remission Taxation Estimate
Spouse/Dependent Graduate Tax Estimate

Voluntary Accidental Death and Dismemberment
Voluntary Accidental Death and Dismemberment Application

Voluntary Excess Life Insurance
Enrollment Form

Long Term Care Insurance
Long Term Care Enrollment Form (employee and spouse/domestic partner)
Long Term Care Enrollment Form (eligible family members)
Evidence of Insurability