Benefit Forms

Health   Dental   FSA   Life   Disability   Retirement   Commuter   Aflac  Pet Assure      

Click on the links below to download the appropriate form.  If you need a form that is not listed, please call the University Benefits Office at (646) 592-4340.

Health Insurance

Dental Insurance

  • Aetna Dental Claim Form - use this form to submit a claim to Aetna if you have used a non-participating provider while using the PPO plan.

HSA/FSA/Reimbursement Accounts

Commuter Benefit Forms

Life Insurance Forms

  • Beneficiary Designation - use this form to designate a beneficiary or beneficiaries who will receive your life insurance benefits if you die. 
  • Evidence of Insurability - use this form if your are electing life insurance in excess of the guaranteed issue amount. Excess coverage EOI is approved by the insurance coverage.

Disability Accommodations

Retirement Plan

High Schools Retirement Plan 


Pet Assure 

Please submit forms to the Benefits Office.