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Human Resources

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HUMAN RESOURCES

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Forms | Retirement information | Contact us

Benefits Information

Western Oregon University, through the Public Employees Benefit Board, more commonly known as PEBB, offers a comrehensive benefit plan for employees including medical, dental, vision, life insurance and other optional benefits. PEBB's Summary Plan Description and our quick benefits overview contain useful information regarding the benefits package provided at WOU. Please feel free to contact us if you have questions about benefits or any information provided on this site.To view your current benefit information or to enroll in benefits as a new employee please access the PEBB.Benefits Member Module. If there is any information that you would like to see available on the benefits page, your suggestions are always welcome, just drop us an e-mail!

New Employees

Newly benefit-eligible employees may now enroll for benefits online! Please see our New Employee Benefits Information Page for detailed information about enrolling for benefits using the Pebb.Benefits Member Module . Need additional assistance using the PEBB.Benefits Member Module to enroll for benefits? Try our guide to enrolling online.

Weight Watchers

• Enrollment Information
• Re-Enrollment Form

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Forms:

2012 Benefits Enrollment Forms
Employee Enrollment (core and optionals)
Flexible Spending Account
UNUM LTC Enrollment Form
Medical History Statement (printable)
Medical History Statement (Submit online)
Affidavit of Dependency

Update Forms (Mid-year changes)
Mid-year Update Form
Flexible Spending Account Update Form
Life Insurance Portability
Long Term Care and Continuation of Coverage
Salary Reduction Agreement (403b)
Mid-year Tobacco-Use Program

Domestic Partner Benefits
Domestic Partnership Information
Affidavit of Domestic Partnership
Domestic Partnership Termination
Staff Fee Affidavit of Domestic Partnership

Staff Fee Privileges
Staff Fees Form- Employee
Staff Fees Form- Family Transfer
Staff Fee Affidavit of Domestic Parnership
Programs Excluded from Staff Fees
Q & A

Flexible Spending Account Information & Forms
Flexible Spending Account General Info Page
Flexible Spending Account Claim Form
Flexible Spending Account Direct Deposit
Flex Debit Request Form

Standard Life Insurance & Disability
Long Term Disability Certificate
Short Term Disability Certificate
Disability Claim Form
Optional Life Insurance Certificate
The Standard Insurance Company

UNUM Long Term Care
Information on Enrolling in Long Term Care
Employee Enrollment Form
Spouse/Domestic Partner Enrollment Form
Family Enrollment Form

FMLA Information & Forms
WOU FMLA Information
Release to Return to Work Form
Leave Request Form
FMLA Attendance Record
Certification of Health Provider - Employee
Certification of Health Provider - Family Member

Other Important Benefit Links
OUS
PEBB
PERS
Kaiser Permenente
Willamette Dental
ODS Dental
Providence Health Plan
Samaritan Health Plan
VSP
ASI Flex
BenefitHelp Solutions
Employee Assistance Program
HR Forms Page
Teaching Research Child Development Center

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Retirement information:

• OUS Retirement & Savings Plan Page

Classified Employees
PERS/OPSRP
Oregon Savings Growth Plan (457)
TDI Accounts (403B)
Salary Reduction Agreement
TDI Guide

Unclassified Employees
PERS/OPSRP
ORP:ous
Choices: Retirement Decision Making Guide
Fidelity
TIAA-CREF
Oregon Savings Growth Plan (457)
TDI Accounts (403B)
Salary Reduction Agreement
TDI Guide

Important Forms
ORP Change Form
IAP: Pre-Retirement Designation of Beneficiary Packet
IAP: Retirement Designation of Beneficiary Packet

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Contact

Office of Human Resources 503-838-8490 | or e-mail: fordhamk@wou.edu