Benefits
Forms
Benefits
- For Basic Life Insurance, Optional Life Insurance and VRS Retirement
- Participants in the VCU Faculty Optional Retirement Plan (ORP) use this only to designate life insurance beneficiaries
For the VCU Faculty Optional Retirement Plan (ORP), VCU Tax-Deferred Annuity (TDA) and Cash Match accounts, and the Virginia Deferred Compensation Plan (DCP), see the following vendor websites or contact the vendor directly for appropriate beneficiary forms
- Fidelity Investments (for ORP, TDA and Cash Match)
- TIAA-CREF (for ORP, TDA and Cash Match)
- ING (for DCP only)
Claim Forms
- Anthem Claim form
- Blue Card Worldwide International Claim Form (for COVA Care international claims)
- Blue View Vision Out-of-Network Claim form
- Delta Dental Claim form
- Dependent Care Reimbursement form
- Medical Reimbursement form
Deferred Compensation Plan (DCP) Enrollment Form (457)
Deferred Compensation Plan (DCP) Payroll Authorization Form
Deferred Compensation Plan (DCP) Payroll Authorization Form - One Time Deferral
- for purchase of VRS service credit
Flexible Reimbursement Account (FRA) – Enrollment Form 
(effective through June 30, 2013)
Flexible Reimbursement Account (FRA) – Enrollment Form (effective beginning July 1, 2013)
Health Benefits Enrollment Form (effective through June 30, 2013)
Health Benefits Enrollment Form (effective beginning July 1, 2013)
Health Insurance Program Appeal Form
Open Enrollment Checklist (for health benefits and flexible spending changes effective July 1, 2013)
Optional Life Insurance Enrollment Form
Optional Life Insurance Evidence of Insurability Form
Optional Group Life Insurance Request for Change
Prescription Drug Prior Authorization Form
- for extended travel
Salary Reduction Agreement (SRA) for VCU Tax-Deferred Annuity (TDA)
- for submitting a change(s)
Tax-Deferred Annuity (TDA): Auto-Enrollment, New-Hire Opt-Out Form
- for new faculty and classified staff
- VRS new member enrollment form (faculty only)
