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Benefits

Health Forms and Resources

Medical - BlueCross BlueShield of Texas

  • Medical Claim Form

Prescription - Prime Therapeutics

  • Prescription Drug Claim Form
  • PrimeMail New Prescription Fax Order Form
  • PrimeMail Prescription Order Form

Dental - BlueCross BlueShield of Texas

  • Claim Form
  • Student Certification

Vision - VSP

  • Out-of-Network Claim Form

Flexible Spending Accounts - Discovery Benefits

  • Automatic Dependent Care Request Form
  • Automatic Orthodontia Request Form
  • Direct Deposit Enrollment/Change Form
  • Reimbursement Request Form
  • Instructions: Request a Debit Card Online
  • Medical Necessity Form
  • Receipt and Substantiation Form

Health Savings Account - BenefitWallet

  • Deposit Slip

Leave of Absence

  • Family Medical Leave Act - Certification of Health Provider
  • Leave of Absence Form - Staff

Miscellaneous

  • Employee Name Change Form
  • Termination Form

Forms

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  • Exiting SMU Forms
  • Performance Review Forms
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