UACES Facebook Employee Benefits Templates

Employee Benefits Templates

 

EBEN-108: University of Arkansas Superior Vision Plan Enrollment Application

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Download:

EBEN-108

 

EBEN-110: Health Savings Account (HSA) Enrollment Form; (Must be enrolled in the Health Savings Plan)

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CESP 8-2

Download:

EBEN-110 Health Savings Account (HSA) Enrollment Form

 

EBEN 112: University of Arkansas Flexible Benefits Plan Enrollment Form

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CESP 8-21

Download:

EBEN-112 (PDF)

 

Cafeteria Plan: Dependent Care Reimbursement and/or Health Care Reimbursement Request 

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CESP 8-21

Download:

UMR Flexible Spending Reimbursement Form (PDF)

 

EBEN-103: Catastrophic Leave Bank Program Donor Application Form.

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CESP 7-8

Download:

EBEN - 103

 

EBEN-105: Dental Enrollment Application; Cancellation of Coverage; Add/Changes to Coverage.

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CESP 8-24

Download:

EBEN - 105 (pdf)

 

EBEN-106: University of Arkansas Health Insurance Enrollment Application

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CESP 8-2

Download:

EBEN - 106 (pdf) 

 

EBEN-107: Application for Maternity Leave

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CESP 7-13

 

EBEN - 107

 

EBEN-109: Employee Request - Leave for Study

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CESP 3-35

Download:

EBEN - 109

 

EBEN-226: University of Arkansas Group Benefits Change Form

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Download:

EBEN - 226

 

EBEN-227: University of Arkansas Group Benefits Enrollment Form

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Download:

EBEN - 227 

 

EBEN-228: Voluntary Salary Deferral Agreement Form

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Download:

EBEN - 228 

 

EBEN-231: Request for Consideration Under the Family and Medical Leave Act

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CESP 7-18

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EBEN - 231

 

EBEN-327: Request for Leave

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CESP 7-4 
CESP 7-7

Download:

EBEN - 327

 

EBEN-370: U of A Cooperative Extension Service Catastrophic Leave Bank Program Physician's Certification

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CESP 7-8

Download:

EBEN - 370

 

EBEN-371A: U of A Cooperative Extension Service Catastrophic Leave Bank Program Application for Medical Emergency Due to Illness/Injury

View Policy: CESP 7-8
Download: EBEN-371A

 

EBEN-371B: U of A Cooperative Extension Service Catastrophic Leave Bank Program Application for Medical Extension Request

View Policy: CESP 7-8
Download: EBEN-371B

 

EBEN-371C: U of A Cooperative Extension Service Catastrophic Leave Bank Program Application for Maternity Purposes

View Policy: CESP 7-8
Download: EBEN-371C

 

PMGS 17-A Employee Request for Registration Fee Discount

PMGS 17-B Request for Registration Fee Discount for Spouse