Forms from Previous Plan Years

• IIT Health Plan Comparison (until 12/31/2007)
• Network PPO
  • Network PPO Benefit Summary Through 5/31/07
  • Plan Document (through 12/31/07)
• PPO
  • PPO Benefit Summary Through 5/31/07
  • Plan Document (through 12/31/07)

Dental Insurance Forms and Pamphlets - Aetna
*Until 12/31/07*

• Enrollment and Change Form
• IIT Dental Plan Comparison
• Dental Claim Form
• Dental Provider Search Instructions
• Online Access Pamphlet
• DMO
  • Pamphlet
  • Benefit Summary
  • Combined DMO Summary Plan Description & Plan Document
  • Dental Riders
  • California Dental DMO Rider
• PPO
  • Pamphlet
  • Benefit Summary
  • Combined PPO Summary Plan Description & Plan Document
  • Dental Riders
  • California Dental PPO Rider

Plan Documents/Summary Plan Descriptions/Benefit Summaries

• Medical Network PPO Benefit Summary Through 5/31/07- Blue Cross Blue Shield
• Medical PPO Benefit Summary Through 5/31/07 - Blue Cross Blue Shield
• Combined DMO Summary Plan Description & Plan Document - Aetna
• Combined PPO Summary Plan Description & Plan Document - Aetna
• Dental Riders - Aetna
• California Dental DMO Rider - Aetna
• California Dental PPO Rider - Aetna
• Life Insurance - CIGNA
• AD&D Insurance - CIGNA
• Voluntary AD&D Insurance - CIGNA
• Long-Term Disability Insurance (Faculty & Administrative Officers) - The Standard
• Long-Term Disability Insurance (Staff) - UNUM
• Long-Term Disability Insurance (Staff) Plan Amendment - UNUM
• Long-Term Disability (Staff) Erisa Statement - UNUM
• Flexible Spending
• 403(b) Retirement Plan Document

Summary Annual Reports

• Life and AD&D - CIGNA - 2005
• Medical - Blue Cross Blue Shield - 2005
• Medical - Blue Cross Blue Shield - 2006
• Long-Term Disability - The Standard - 2005
• Long-Term Disability - The Standard - 2006
• Long-Term Disability - UNUM - 2005
• Long-Term Disability - UNUM - 2006
• Life and AD&D - CIGNA - 2006
• 403(b) Retirement Plan - 2005
• 403(b) Retirement Plan - 2006

United Way

• Charitable Contribution Form

Retirement Plan - 403(b)

• Retirement Plan Salary Reduction Agreement
• Retirement Plan IRS Maximums

• TIAA-CREF
  • Enrollment Form (Contact HR)
  • Transfer/Rollover Form (Submit Form to HR)
  • TIAA-CREF Prospectus Information
  • Beneficiary Change Form
  • Loan Information
  • Hardship Withdrawal Information
  • Online Account Registration
• Fidelity
  • Enrollment Form (Submit Form to HR)
  • Transfer/Rollover Form (Submit Form to HR)
  • Fidelity Fund/Prospectus Information
  • Beneficiary Change Form
  • Loan Information
  • Hardship Withdrawal Information
  • Online Account Registration

Accomodation Request

• Accomodation Request Form

Leave of Absence

• Request for Leave of Absence
  
• Certification of Health Care Provider
  
• Return to Work Medical Certification

Supervisor's Forms

• Justification for position
• Performance Appraisal **Updated 7/1/2007**
• Performance Appraisal (word doc) **Updated 7/1/2007**
  
• Supervisory Investigation Report
  (Employee Work-Related Injury or Illness)
  

Exit Interview

• Exit Interview