When e-mailing forms to askhr@wayne.edu, please be sure to use your WSU E-mail and include "#SECURE" in the subject line to ensure your personal information is encrypted. If you're not using WSU E-mail, be sure to encrypt your message. Forms may also be faxed to: 313-577-0637

• Handbooks

  Active Employee Benefits Handbook
  Retiree, Surviving Spouse and Long-Term Disability Recipient Benefits Handbook

• Medical, Dental & Vision Insurance

  To enroll in or terminate medical, dental, vision or Cash in Lieu of Medical benefits for yourself and/or your dependents: As a New Employee (within 45 days of your hire date)  During a Life Status Change Event (within 30 days of event) During Open Enrollment Log In to Enroll or Make Changes  or follow these steps: Log into Academica Click 'Employee Resources' Click 'Employee Self-Service' Click 'Benefit Plan Enrollment & Changes' Click here for full instructions For customer service, call Businessolver's Wayne State Benefits Center: 888-907-1433 Dependents & Supporting Documentation
  Delta Dental Claim Form	Use to submit an out-of-network claim.
  EyeMed Out of Network Claim Form	Most EyeMed Vision Care plans allow members the choice to visit an in-network or out-of-network vision care provider. You only need to complete this form if you are visiting a provider that is not a participating provider on the EyeMed network.

• Retirement Savings Plans

  To make changes or enroll in 403(b) or 457(b) plans, log in here or:

  1. Log into Academica
  2. Click 'Employee Resources'
  3. Click 'Employee Self-Service'
  4. Click 'Retirement Savings Plan Enrollments and Changes'

  Download this quick guide to get started

• Life Insurance

  To enroll in or make changes to your life insurance coverage, enroll your dependents in the dependent life insurance plan, and update your beneficiaries: Log In to Enroll or Make Changes  or follow these steps: Log into Academica Click 'Employee Resources' Click 'Employee Self-Service' Click 'Benefit Plan Enrollment & Changes' For customer service, call Businessolver's Wayne State Benefits Center: 888-907-1433
  Evidence of Insurability Application	Submit this application to Sun Life Financial when requesting an increase your life insurance coverage.  Must also submit a Basic and Supplemental Life/AD&D Enrollment/Change Form to the HR Service Center.
  Conversion and Portability Application	WSU fills this out for you (upon your request) during the conversion and portability process.
  Portability Kit	This kit will help guide you through the Portability process.
  Conversion Kit	This kit will help guide you through the Conversion process.
  Death Benefits Claim Packet	Use this form to file a Life Insurance claim in the event of a death of a WSU employee or their covered dependent.

• Flexible Spending Accounts

  To establish a flexible spending account: Log In to Enroll or Make Changes  or follow these steps: Log into Academica Click 'Employee Resources' Click 'Employee Self-Service' Click 'Benefit Plan Enrollment & Changes' For customer service, call Businessolver's Wayne State Benefits Center: 888-907-1433
  Out-of-Pocket Reimbursement Request Form	Use this form for reimbursement of any out-of-pocket expenses (Medical and/or Dependent Care) where your Discovery Benefits debit card was not used.
  Recurring Dependent Care Request Form	This form is to be completed each plan year and as changes occur when the participant wants to receive recurring reimbursement of dependent care expenses.

• Tuition Assistance

  Employee Tuition Assistance Application

  To use the online application, simply: Register for your courses Have your employee Access ID (i.e. aa1111) ready and go to: https://tuitionbenefit.apps.wayne.edu  Once you access the link you will select the semester, click the course/s that we should apply the tuition award to, and then follow the system prompts until you hit the submit button on the final page.

  Spouse/Child Reduced Tuition Application

  To use the online application, simply have your employee Access ID (i.e. aa1111) ready and go to: https://tuitionbenefit.apps.wayne.edu/dependents  Once you access the link you will click the 'dependents' button, click the semester that the Reduced Tuition for Spouse/Child benefit should be applied to, carefully read the questions and follow the system prompts, sign the online request, and click the 'agree' button to finalize your request.

• Leave of Absence/FMLA

  FMLA/Leave of Absence Benefit Continuation Application Form	Use this form to continue benefits while on leave of absence.
  Physician's Report on Illness	To return to work, the employee will have this form filled out by the attending physician or surgeon. Refer to WSU Administrative Policies Procedures and/or applicable Collective Bargaining Agreement for specific guidelines.
  FMLA Claim Submission Checklist	Step-by-step instructions on what you need to do to apply for an FMLA leave.

• Long-Term Disability

  LTD Booklet Certificate	The terms of the Group LTD Insurance policy are contained in this document.
  Employee Application for Long-term Disability Income Benefits	Use this form to apply for disability benefits. This is NOT an enrollment form for disability insurance.
  Physician's Statement of Disability
  Retiree, Surviving Spouse and Long-Term Disability Recipient Benefits Handbook	The benefits handbook for those retired or retiring from university service, long-term disability recipients and surviving spouses.
  Dental Plan Election Form	Retirees, surviving spouses and long-term disability recipients use this form to enroll in, change or terminate a Wayne State University dental plan.
  Vision Plan Election Form	Retirees, surviving spouses and long-term disability recipients use this form to enroll in, change or terminate a Wayne State University vision plan.
  Medical Plan Election Form	Retirees, surviving spouses and long-term disability recipients use this form to enroll in, change or terminate a Wayne State University medical plan.
  Life Insurance Beneficiary Designation Form	Retirees and long-term disability recipients use this form to edit life insurance beneficiaries.

• Retiring/Retirees

  Retiree, Surviving Spouse and Long-Term Disability Recipient Benefits Handbook	The benefits handbook for those retired or retiring from university service, long-term disability recipients and surviving spouses.
  Dental Plan Election Form	Retirees, surviving spouses and long-term disability recipients use this form to enroll in, change or terminate a Wayne State University dental plan.
  Vision Plan Election Form	Retirees, surviving spouses and long-term disability recipients use this form to enroll in, change or terminate a Wayne State University vision plan.
  Medical Plan Election Form	Retirees, surviving spouses and long-term disability recipients use this form to enroll in, change or terminate a Wayne State University medical plan.
  2024 Aetna Medicare Plan (PPO) Enrollment Form	New Medicare-eligible retirees and their Medicare-eligible spouses use this form to enroll in the Group Aetna Medicare Plan (PPO).
  HAP Senior Plus HMO Enrollment Form	New Medicare-eligible retirees and their Medicare-eligible spouses use this form to enroll in the Group HAP Senior Plus HMO Plan.
  Life Insurance Beneficiary Designation Form	Retirees and long-term disability recipients use this form to edit life insurance beneficiaries.