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)
- Dependent Care Flexible Spending Account Reimbursement Form (PDF)
- Flexible Spending Account Enrollment or Change Form (PDF)
- Reasonable Accommodation Request Form (PDF)
Health & Medical Plans
- 2011 Summary Annual Report for MIT Flexible Reimbursement Account Plan (PDF)
- 2011 Summary Annual Report for MIT Long-Term Care Plan (PDF)
- 2011 Summary Annual Report for Travel Accident Plan (PDF)
- 2011 Summary Annual Report for MIT Retiree Dental Plan (PDF)
- 2011 Summary Annual Report for MIT Vision Care Plan (PDF)
- 2012 Summary Annual Report for MIT Retiree Welfare Benefit Plan (PDF)
- 2013 Summary of Benefits: MIT Choice Plan (PDF)
- 2013 Summary of Benefits: MIT Traditional Plan (PDF)
- 2013 Summary of Benefits: Prescription Coverage - Express Scripts (PDF)
- Affidavit of Domestic Partnership (PDF)
- COBRA Premium Reduction Provisions (PDF)
- Dental Plan Enrollment/Change Form for Postdoctoral Fellows (PDF)
- Dental Plan Coverage Chart: Basic (PDF)
- Dental Plan Coverage Chart: Comprehensive (PDF)
- Declaration of Termination of Domestic Partnership (PDF)
- Domestic Partner Health Coverage Taxable Income & Costs (PDF)
- Early Retiree Reinsurance Program - Notice (PDF)
- EyeMed Out of Network Claim Form (PDF)
- Health Care FSA Eligible Expenses (PDF)
- Health Care FSA Enrollment/Change Form (PDF)
- Health Care Flexible Spending Account Ineligible Item Repayment Form (PDF)
- Health Care FSA Reimbursement Form (PDF)
- Healthcare Program Coverage for the Former Spouse of an Employee or Retiree (PDF)
- Health/Dental/Vision Plan Enrollment/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
- 2011 Summary Annual Report for MIT Group Life Insurance Plan (PDF)
- 2012 Summary Annual Report for MIT Group Life Insurance 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
- 2011 457(b) Plan Deferral Agreement Form (PDF)
- 2011 457(b) Plan Program Description (PDF)
- 401(k) Plan Beneficiary Designation Form
- 401(k) Plan Distribution Options Brochure (PDF)
- 401(k) Plan Enrollment Guide (PDF)
- 401(k) Plan Guide to MIT Asset Class Options (PDF)
- 401(k) Plan Rollover Form
- 401(k) Plan Safe Harbor Notice (PDF)
- 401(k) Plan Summary Plan Description (PDF)
- 401(k) Plan Summary Annual Report (PDF)
- Application for Benefits-Eligible Credit for Prior Employment - Non-profit (PDF)
- Application for Benefits-Eligible Credit for Prior Employment - Temporary Employee (PDF)
- Pension Plan Erisa-PPA Required 5500 Tax Extracts (PDF)
- Pension Plan Annual Funding Notice (PDF)
- Pension Plan 2011 204(h) Notice (PDF)
- Pension Plan Direct Deposit Form (online at PensionConnect)
- Pension Plan Beneficiary Designation Form (online at PensionConnect)
- Pension Plan Summary Plan Description (PDF)
Tuition & Education
- Children's Scholarship Plan Application (PDF)
- Children's Scholarship Plan Booklet (PDF)
- Children's Scholarship Plan Change Form (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)
- Fitness Benefit Forms
- Required Notices
