Forms & Publications
Find frequently-used Benefits forms, charts and publications below. See plan detail pages for additional forms and publications you might need.
Life Events
- Adoption Assistance Plan Application (PDF)
- Dependent Care Flexible Spending Account Enrollment/Change Form (PDF)
- Flexible Spending Account Enrollment or Change Form (PDF)
- Reasonable Accommodation Request Form (PDF)
Health & Medical Plans
- 2008 Summary Annual Report for MIT Flexible Reimbursement Account Plan (PDF)
- 2008 Summary Annual Report for MIT Vision Care Plan (PDF)
- Affidavit of Domestic Partnership (PDF)
- Dental Plan Enrollment/Change Form for Postdoctoral Fellows (PDF)
- Dental Plan Coverage Chart: Basic (PDF)
- Dental Plan Coverage Chart: Comprehensive (PDF)
- COBRA Premium Reduction Provisions (PDF)
- Declaration of Termination of Domestic Partnership (PDF)
- Domestic Partner Health Coverage Taxable Income & Costs (PDF)
- EyeMed Out of Network Claim Form (PDF)
- Health Care Comparison Chart (PDF)
- Health Care FSA Enrollment/Change Form (PDF)
- Health Care FSA Reimbursement Form (PDF)
- Health/Dental/Vision Plan Enrollment Form (PDF)
- Health/Dental/Vision Plan Change Form (PDF)
- Medicare Supplement Plans Comparison Chart (PDF)
- Prescription Drug Benefit: Home Delivery Form for New Patients (PDF)
- Prescription Drug Benefit: Claim Form (PDF)
- Retiree Dental Plan Enrollment Form (PDF)
- Retiree Health Plan Enrollment Form (PDF)
More about Health & Medical Plans.
Life & Disability Insurance
- 2008 Summary Annual Report for MIT Long-Term Care Plan (PDF)
- 2008 Summary Annual Report for Travel Accident Plan (PDF)
- Dependent Life Insurance Enrollment/Change Form (PDF)
- Group Life Insurance Plan Description (PDF)
- Life Insurance Beneficiary Designation Form (PDF)
- Life Insurance Enrollment/Change Form (PDF)
- Long-Term Disability Summary Plan Description (PDF)
- Statement of Health (PDF)
- Will Preparation Service (PDF)
- Workers' Compensation: Instructions to Employees Injured on the Job (PDF)
More about Life & Disability Insurance.
Retirement
- 401(k) Plan Beneficiary Designation Form (PDF)
- 401(k) Plan Distribution Options Brochure (PDF)
- 401(k) Plan Guide to Investment Options (PDF)
- 401(k) Plan Rollover Form (PDF)
- 401(k) Plan Summary Plan Description (PDF)
- 401(k) Plan Summary Annual Report (PDF)
- MIT 457(b) Voluntary Compensation Deferral Agreement (PDF)
- MIT 457(b) Qualified Deferred Compensation Plan 2009 Program Description (PDF)
- Basic Retirement Plan 2008 Erisa-PPA Required 5500 Tax Extracts (PDF)
- Basic Retirement Plan Beneficiary Designation Form (PDF)
- Basic Retirement Plan Direct Deposit Form (PDF)
- Basic Retirement Plan Election of Annuity Form (PDF)
- Basic Retirement Plan Election of Lump-Sum Benefit Form (PDF)
- Basic Retirement Plan Summary Plan Description (PDF)
Tuition & Education
- Children's Scholarship Plan Application (PDF)
- Children's Scholarship Plan Booklet (PDF)
- Educational Loan Plan Application (PDF)
- Tuition Assistance Career Development Proposal Form
- Tuition Assistance Plan Summary Plan Description (SPD) (PDF)
More about Tuition & Education.
Other
- Benefits Summary (PDF)
- Change of Address Form (Active employees only; MIT certificate required)
- Change of Address Form (Retirees and former staff only)
