Benefit Forms

If you can not find the form you are looking for, or need additional information about the form you downloaded please contact benefits@scripps.edu or (858) 784-8487.

Health and Welfare Change Forms

You may add or remove a dependent in the event of a qualified Status Change.  You are encouraged to review the status change definitions before downloading the form; in some cases supporting documentation is needed.  You must add or remove a dependent within 31 days of the status change.

To add or remove a dependent from your coverage please select the form that is applicable to your position. Proof of a status change is required. You must also provide proof of dependency if adding a dependent to the plan. For more information on what documentation to provide click here.

Scientific and Support Staff Benefits Coverage Change Form (e.g. Professors, Technicians, Administrative Assistants) - Use this form to add or remove dependents on your medical, dental benefits.
California
Florida

Research Associate/Scholar Benefits Coverage Change Form - Use this form to add or remove dependents on your medical, dental benefits.
California
Florida

Graduate Student Benefits Coverage Change Form - Use this form to add or remove dependents on your medical, dental benefits.
California
Florida

Health Plan Forms

Principal Medical Reimbursement Form

Medical Waiver Form

Caremark Forms

HMO Forms

UBH Reimbursement Form

Dental Delta Reimbursement Form

MES Vision Claim Form (CA Participants)

Flexible Spending Account Forms

Retirement Plan Forms

Tax Sheltered Annuity (403(b)) Plan

Cash Balance Retirement Plan

TSRI Faculty and Management Retirement (401(a)) Plan

Deferred Compensation (457(b)) Plan

Beneficiary Forms

Life Insurance Beneficiary Form

Business Travel Accident Beneficiary Form

Cash Balance Retirement Plan Beneficiary Form

TSRI Faculty and Management Retirement (401(a)) Plan Beneficiary Form

Tax Sheltered Annuity (403(b)) Beneficiary Form

Deferred Compensation (457(b)) Plan Beneficiary Form

Other Benefit Forms

Injury Report

Transit Benefit Enrollment Form

Tuition Reimbursement Form 

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