Benefit Forms
The forms below are available in printable format.
Endowed Health and Dental Insurance
- Cornell Program for Healthy Living (PDF)
- 2009 Aetna HSA Plan (PDF) // 2010 Aetna HSA Plan (PDF)
- Aetna Open Choice Enrollment Form (PDF)
- Aetna 80/20 Enrollment Form (PDF)
- Aetna Claim Form (PDF)
- First Ameritas Dental Claim Form (PDF)
- First Ameritas Dental Enrollment Form
(PDF)
- First Ameritas Eye Care Claim Form (PDF)
- ValueOptions Claim Form: Endowed (PDF)
- HealthNow Enrollment Form (PDF)
- HealthNow Claim Form (PDF)
- Medco Home Delivery Form (PDF)
- Medco Reimbursement Form (PDF)
Additional benefits forms may be obtained by contacting Benefit Services, 255-3936, or e-mail benefits@cornell.edu.
Form more information on Cornell's benefit programs, refer to our benefits pages.