Indiana University Southeast | Office of Human Resources (HR) | Employee Benefits Forms

More Info For:

More Info About IUS:

Employee Benefits Forms

IU Tuition Benefit

IU Tuition Benefit Enrollment Form

HEALTH, DENTAL & PRESCRIPTION PLANS

Medical Care

IU HDHP, IU PPO $900 Deductible and Blue Access PPO $400 Deductible Plans Claim Form (PDF)

Prescription Claim Form

Medco Claim Form (PDF)

Dental Plan

Dental Claim Form (CIGNA) (PDF)

INSURANCE PLANS

Beneficiary forms

Basic Life Insurance (PDF)

Personal Accident Insurance (PDF)

Supplemental Group Life Insurance (PDF)

RETIREMENT

IU Retirement Savings Plan 457(b)

IU Tax Deferred Annuity Plan 403 (b)

TAX SAVER BENEFIT (TSB) PLAN

Claim Form (PDF)
Direct Deposit Authorization/Termination form (PDF)
Dependent Care Flexible Spending Account Worksheet (PDF)

See the Benefits Change Connection about making changes to plans.