Benefits Forms

Choose a topic:

New Employee Benefits Enrollment Forms
General Forms
Insurance Forms
Retirement Forms
Leave Forms
Workers' Compensation Forms

New Employee Benefits Enrollment Forms

Overview of A&M System benefit/retirement programs
New Employee Benefits Enrollment Form
Beneficiary Designation Form
Dependent Enrollment Form/Certification (if applicable)

General Forms

New Employee Processing Forms can be found within the New Employee Orientation Toolkit, a one-stop location for required processes and best practices for orienting a new employee at Texas A&M University.

Direct Deposit Authorization: Used to establish direct deposit of payroll checks into an employee's bank account.

Employee Personal Data Form: Required of all new employees.
Current employees may update their personal data online through HRConnect.

Insurance Forms

Insurance Premium Bank Draft Authorization: Authorization for the university to draft your bank account for group insurance premiums.

Annual Enrollment Form Used to make Annual Enrollment corrections. Mail completed and signed form to ESC, MS 1255.

Beneficiary Designation Form: Used to designate the beneficiary for Basic Life Insurance, Optional Life Insurance, and Accidental Death and Dismemberment policies.

Benefit Change Form: Used to change Health, Dental, Optional Life, Dependent Life, Accidental Death and Dismemberment, Long-Term Disability, or Long-Term Care coverages after the annual enrollment period has ended.

Long-Term Care Forms: Login via John Hancock's web site (Username in all caps = TAMUS; Password in all lowercase = mybenefit).

Dependent Enrollment Form/Certification

Apply for Life Insurance: (complete both forms)

Statement of Health Questionnaire Form: To apply for life insurance with Fort Dearborn, complete this form and mail it to:
Ft. Dearborn Life Insurance Co.
PO Box 655403
Dallas, Tx. 75265
Life Insurance Enrollment Form: In addition to the statement of health questionnaire, complete this form and mail it to:
ESC
MS 1255

Life Insurance Portability Form: Portability is an option for Optional Life and Dependent Life participants (employee and spouse only) whose coverages are decreasing because they are retiring or ending because they are no longer eligible or are leaving A&M System employment. This option is available until age 70 and allows participants to keep their same level of coverage by paying higher premiums.

New Employee Benefit Enrollment Form

Optional AD&D Enrollment and Spouse Waiver Form (FORM NO LONGER IN USE)

Survivor Health/Dental/Vision Continuation Form: Use in the event of the death of an employee or retiree, so a surviving spouse who meets the eligibility requirements can continue health and/or dental coverage indefinitely.

Payflex Plan: Claim Form and Filing Instructions.

Retirement Forms

TRS Forms online

Tax-Deferred Account Maximum Contribution Limit Worksheet (HR-10)

Prior ORP Participation Acknowledgment Form (HR-11)

ORP Information Acknowledgment Form (HR-12)

ORP/TDA Representative Acknowledgment Form (HR-13)

ORP Salary Reduction Acknowledgment/Change of Vendor (HR-14)

ORP Notification of Change in Employment Status (HR-15)

ORP/TDA Transfer Verification Form (HR-16)

TDA Salary Reduction Agreement/Change of Vendor Form (HR-17)

Active ORP/TDA Vendors

Medicare Coordination Acknowledgment Form (HR-106)

Retiree Benefit Form: Used by retirees to change from active to retiree status or, during retirement, evidence of insurability. Must be returned to the ESC, MS 1255. (HR-107)