University Physicians, Inc.

Benefit Forms

Benefits Enrollment/Change Form
Enrollment/Change Form

Common Law Marriage/Same Gender Domestic Partner Forms
UPI Common Law Marriage Affidavit
Same Gender Domestic Partner Affidavit
Same Gender Domestic Partner Tax Certification

Optional Life Insurance Form
Medical History Statement

Short-Term Disability Form
Medical History Statement

Health Care and Dependent Care Flexible Spending Account Forms
Claim Form
Direct Deposit Form