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COVID-19 (Coronavirus)
UMBC campuses are closed, but courses are now online and employees are working remotely.

Benefits Forms

Having trouble finding what you’re looking for? Please try using the search bar at the top of the page, or email hrbenefits@umbc.edu for general Benefit questions.

General

Change of Name/Address Process

Tuition Remission

Tuition Remission (now online!)

Health Benefits

Benefit Enrollment is online in the SPS Workday System

Retiree Enrollment Form for 2020
HIPPA Authorization Form
CHIP Acknowledgement 
COBRA Enrollment Form for 2020

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

* Instructions to Submit SRA forms during COVID-19

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) 
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