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
- 2019 Employee Enrollment/Change Form
- 2018 Employee Enrollment/Change Form
- Premium Payment Plan Election/Change
- Valid Dependent Verification Documents – required if adding a spouse/state registered domestic partner and/or children.
- Dependent Eligibility Worksheet
- 2019 Declaration of Tax Status
- 2018 Declaration of Tax Status
- Certification of Dependents with Disabilities
- 2019 Extended Dependent Certification
- 2018 Extended Dependent Certification
- 2019 Premium Surcharge Change Form
- 2018 Premium Surcharge Change Form
- 2019 Premium Surcharge Help Sheet
- 2018 Premium Surcharge Help Sheet
Long Term Disability
- Metlife Employee Enrollment Form
- Metlife Beneficiary Designation
- Metlife Statement of Health
- MetLife Cancellation Form
Flexible Spending Account (FSA) Dependent Care Assistance Program (DCAP)
- 2019 FSA & DCAP Enrollment Form
- 2018 FSA & DCAP Enrollment Form
- FSA & DCAP Change Form Allows you to make changes to an account for qualifying events.
- FSA Direct Deposit Authorization/Flexi-Card Enrollment
- Recurring Day Care Claim Instruction Guide
- FSA/DCAP Claim Form
Health Savings Account (HSA)
- 2019 Employee Authorization for Payroll Deduction to HSA
- 2018 Employee Authorization for Payroll Deduction to HSA
- Health Savings Account Beneficiary Designation
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
- Beneficiary Designation
- 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.
Washington State University Retirement Plan (WSURP), TIAA
- Retirement Participation Election Form
- 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
- 2019 Salary Reduction Agreement form: Use this form to designate your desired contribution for the TIAA Voluntary Investment Plan.
- Deferred Compensation Participation Agreement: Use this form to designate your desired contribution for the Deferred Compensation Program (DCP).