Benefits Forms
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General
Change of Name/Address Process
Tuition Remission
Tuition Remission (now online!)
Health Benefits
Benefits Enrollment is online in the SPS Workday System
Retiree Enrollment Form for 2021
HIPPA Authorization Form
CHIP Acknowledgement
COBRA Enrollment Form for 2021
Affidavit/Dependent/Certification Forms
Disabled Dependent Certification Form
Affidavit for Dependent Eligibility and Tax Status
Life Insurance
Beneficiary Form for UNUM Term Life Insurance
MetLife Insurance Beneficiary Form or Beneficiary change online
UNUM Term Life Enrollment Form
Disability
UNUM Long Term Disability Enrollment Form
UNUM Claim for Income Protection Benefits
Accidental Death & Dismemberment
MetLife Accidental Death & Dismemberment Beneficiary Form or Beneficiary Change online
Flexible Spending Account
Flexible Spending Account Log-in
Flexible Spending Claim Form
Leave
Leave forms are available here.
Retirement Forms
Retirement Plan Selection Form
ORP Retiree Health Benefits Handbook
ORP Retiree Forms Packet
Pension Retiree Checklist
ORP Retiree Checklist
Supplemental Retirement Account Forms
TIAA 403 (b) Pre-Tax
Fidelity 403 (b) Pre-Tax
TIAA 457 (b) Pre-Tax
Fidelity 457 (b) Pre-Tax
TIAA 403 (b) Roth After-Tax
Fidelity 403 (b) Roth After-Tax
MSRP Nationwide Supplemental Retirement Initial Enrollment Form (401k, 403b, 457 and Roth)
MSRP Nationwide Supplemental Retirement Plans Deduction Change Form (401k, 403b, 457 and Roth) *
*Existing MSRP Members can change their deductions online at www.marylanddc.com