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Benefits Forms

Flexible Spending

• Flexible Spending Enrollment Form
• Flexible Spending Claim Form 
• Flexible Spending Direct Deposit Agreement

Defined Contribution Plan - Participation Authorization and Salary Reduction Agreement Form

UCCI Dental Insurance

• Enrollment Form - To indicate your plan preference, write either Core or Buy-Up on the top of the form.
• Claim Form
• Waiver of Coverage Form

Group Life Insurance Enrollment/Change Form

Anthem Health Insusrance

• Anthem Enrollment Form
• Member Change Request Form 
• Member Health Care Claim Form 
• Authorization Release Form 
• Waiver of Coverage Form 
• Anthem Prescription Drug Reimbursement Form (Adobe pdf)

Contact Us

• Mailing Address:
  Human Resources
  204 W. Washington Street
  Washington and Lee University
  Lexington, Virginia 24450
  (540) 458-8920, fax: (540) 458-8060