Benefit Forms - Concordia University Texas

Enrollment/Change to Enrollment

Concordia Retirement Savings Plan (CRSP)-403b Enrollment/Change Deduction (PDF)
Request for Member CPS Benefit Change (PDF)
CHP Special Enrollment Application (for Qualifying Life Event-Read Carefully) (PDF)

Beneficiary Forms

CRSP and AIP Beneficiary Designation Form (PDF)
To designate or change Concordia Retirement Plans Beneficiary - Contact Metlife (Scroll down. May require login)

Claim Forms

BCBS Medical Plan Claim Form (PDF)
Cigna Dental Claim Form (PDF)
Express Script Claim Form (PDF)
Express Script Mail Order Form (PDF)
FSA Medical Claim Form (PDF) Read BEFORE Making Claim (PDF)
FSA Dependent Care Claim Form (PDF)

Other Forms/Info

Family Medical Leave Forms (PDF)
Tuition Waiver Request (PDF)
Provider Preventive Care Notice (PDF)
Step Therapy Drug Program Info (PDF)

Human Resources • 11400 Concordia University Drive, Austin, Texas 78726 • 512.313.4472 • jobs@concordia.edu

Concordia University Texas is an Equal Opportunity Employer. The University is an institution of the Concordia University System of The Lutheran Church-Missouri Synod, and to the extent allowed by law, reserves the right to give preference in employment based upon religion.

This page was last updated on Oct. 09, 2012.
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Benefits
- Benefit Forms