Medical & Dental • Premium Surcharges • Long Term Disability • Life Insurance
Health Savings Account • Flexible Spending Account • PERS/TRS Retirement
Washington State Retirement Plan • Voluntary Investment Plans
Medical & Dental
Premium Payment Plan Election/Change
Valid Dependent Verification Documents – required if adding a spouse/state registered domestic partner and/or children.
Dependent Eligibility Worksheet
Certification of Dependents with Disabilities
Flexible Spending Account (FSA)
Dependent Care Assistance Program (DCAP)
2017 FSA & DCAP Enrollment Form
FSA & DCAP Change Form Allows you to make changes to an account for qualifying events.
2016 FSA & DCAP Claim Form
2017 FSA & DCAP Claim Form
FSA Direct Deposit Authorization/Flexi-Card Enrollment
Recurring Day Care Claim Instruction Guide
Health Savings Account (HSA)
Public Employees Retirement Plan (PERS)/Teachers Retirement Plan (TRS)
Member Information Form (for Civil Service, Bargaining Unit and Hourly)
Higher Education Employees Plan 3 Investment Program Form (for Faculty and Administrative Professional)
Plan 3 Change of Investment Program: Choose between the Washington State Investment Board (WSIB) and the Self-Directed Investment Programs.
Name & Address Change : To be completed by inactive members, retirees and beneficiaries receiving benefits. Active members update your address through MyWSU account.
VEBA Enrollment Form
Washington State University Retirement Plan (WSURP), TIAA
How To Enroll Online Guide
10% Increased Contribution: At any time following your 50th birthday you may elect to increase your contribution rate to 10%.
Paper Enrollment Form: Use this form to enroll by mail. Use the How to Enroll Online Guide above to enroll online.
VEBA Enrollment Form
Change of Name: Use this form to update your name on your retirement account. Return completed form to address noted on top of form.
Beneficiary Change via TIAA website: Update your beneficiaries online.
Voluntary Investment Plans
2017 Salary Reduction Agreement: Use this form to designate your desired contribution for the TIAA-CREF Voluntary Investment Plan.
Deferred Compensation Participation Agreement: Use this form to designate your desired contribution for the Deferred Compensation Program (DCP).