HRM Benefits: Benefit Forms

Monday, November 23, 2009 02:09:55 AM

Benefits Home
Benefits Forms
Summary of Insurance Benefits
Summary of Retirement Benefits
Summary of Tax Saver Flexible Benefits Plan
Insurance & Retirement Plan Links
Online Benefits Presentation
Other Benefits
When to Contact Benefits
Have a Question
HRM Homepage

	Benefits > Benefit Forms CNA Long Term Disability Claim Forms: Employee Statement Physician Statement Physical Demands Analysis Authorization to Disclose Authorization for Information CNA Long Term Disability Late Application
	Flexible Spending Account Reimbursement Form Flexible Spending Enrollment / Change Form Health Insurance/ Prudential Life Insurance/ COBRA Election Form (GB-01) Late Applicant Enrollment Forms (due by 14th of the month previous to desired effective date): GB-01 Acknowledgement of Pre-existing Condition and Statement of Physical Condition Insurance Portability Law Application (do not need to complete if you have a Certificate of Prior Coverage) Insurance Acknowledgement Form for New Employees Leave Without Pay Benefits Continuation/Cancellation Form (GI-1) Status Change Form (to be completed along with GB-01) Return to Work Application (re-hired retirees of the Teacher's Retirment System) Retirement Forms Louisiana Deferred Compensation Plan (DCCL) Enrollment Forms Retirement Forms

Benefits Service Center
Office of Human Resource Management
304 Thomas Boyd Hall
Louisiana State University
Baton Rouge, Louisiana 70803
Phone: 225/578-8200
Fax: 225/578-5981

Internet 2 University Member