UACES Facebook Employee Benefits Templates

Employee Benefits Templates

 

E.B.E.N.-108: University of Arkansas Superior Vision Plan Enrollment Application
View Policy  
Download: E.B.E.N.-108
E.B.E.N.-110: Health Savings Account (HSA) Enrollment Form; (Must be enrolled in the Health Savings Plan)
View Policy C.E.S.P. 8-2
Download: E.B.E.N.-110 Health Savings Account (HSA) Enrollment Form

 

E.B.E.N. 112: University of Arkansas Flexible Benefits Plan Enrollment Form
View Policy C.E.S.P. 8-21
Download:

E.B.E.N.-112 (PDF)

Download the latest Adobe Reader  

 

Cafeteria Plan: Dependent Care Reimbursement and/or Health Care Reimbursement Request 
View Policy C.E.S.P. 8-21
Download: UMR Flexible Spending Reimbursement Form (PDF)

  

E.B.E.N.-103: Catastrophic Leave Bank Program Donor Application Form.
View Policy C.E.S.P. 7-8
Download: E.B.E.N. - 103

 

E.B.E.N.-105: Delta Dental Enrollment Application; Cancellation of Coverage; Add/Changes to Coverage.
View Policy C.E.S.P. 8-24
Download: E.B.E.N. - 105 (pdf)

 

E.B.E.N.-106: University of Arkansas Health Insurance Enrollment Application
View Policy C.E.S.P. 8-2
Download: E.B.E.N. - 106 (pdf) 

 

E.B.E.N.-107: Application for Maternity Leave
View Policy C.E.S.P. 7-13
  E.B.E.N. - 107

 

E.B.E.N.-109: Employee Request - Leave for Study
View Policy C.E.S.P. 3-35
Download: E.B.E.N. - 109

  

E.B.E.N.-226: University of Arkansas Group Benefits Change Form
View Policy  
Download: E.B.E.N. - 226

 

E.B.E.N.-227: University of Arkansas Group Benefits Enrollment Form
View Policy  
Download: E.B.E.N. - 227 

 

E.B.E.N.-228: University of Arkansas Optional Retirement Plan Salary Deferral Agreement

View Policy  
Download: E.B.E.N. - 228 

 

E.B.E.N.-231: Request for Consideration Under the Family and Medical Leave Act
View Policy C.E.S.P. 7-18
Download: E.B.E.N. - 231

 

E.B.E.N.-327: Request for Leave
View Policy C.E.S.P. 7-4 
C.E.S.P. 7-7
Download: E.B.E.N. - 327

  

E.B.E.N.-370: U of A Cooperative Extension Service Catastrophic Leave Bank Program Physician's Certification
View Policy C.E.S.P. 7-8
Download: E.B.E.N. - 370

 

E.B.E.N.-371: U of A Cooperative Extension Service Catastrophic Leave Bank Program Recipient Application Form
View Policy C.E.S.P. 7-8
Download: E.B.E.N. - 371 (Microsoft Word)

 

E.B.E.N.-372: U of A Cooperative Extension Service Catastrophic Leave Bank Program Liability Agreement
View Policy C.E.S.P. 7-8
Download: E.B.E.N. - 372