Current Employee Benefits and HR Information
We are pleased to provide a wide array of benefits for our employees. New employees enroll in benefits at the start of their job. Employees can change their choices either annually during the “open enrollment” period in May or with a qualifying event (such as the birth of child or a change in a spouse’s employment).
This page contains a number of forms and documents related to benefits and human resources. Click on a category to find the links. If you have questions about a form or policy, the “HR Tip Sheet” contains contact names and numbers.
Benefits and Insurance Forms for 2019-20 School Year
- Benefit Enrollment Log-in (Vbas)
- Comparison of Plan Benefits for 2019-20 Health Insurance
- Full-Time Employee Health Insurance Rates 2019-20 (includes 18-19 rate info)
- Part-Time Employee Health Insurance Rates 2019-20 includes 18-19 rate info)
- Dental & Vision Insurance Rates 2019-20
- Aetna Mail Order Rx Brochure
- Information about Flexible Spending Accounts and app through WageWorks
- Delta Dental Plan Information
- Eye Med Supplemental Vision Plan
- Information about Aflac Optional Insurances
- Virginia Retirement System Life Insurance Overview
- Optional Additional Life Insurance : see HR
- Other forms and logins
- Employee Assistance Program through U.Va.
Miscellaneous Forms and Information
- HR Tipsheet (contact names & numbers)
- Reimbursement Request
- Mileage Reimbursement Form
- Tuition Reimbursement
- Name/Address Change Form
- Designation of Beneficiary
- Resignation Form
- Request for Resignation Sick Leave Payout
- Sick Leave Transfer Request Form
- Dependent Care Claim Form (WageWorks)
- Medical FSA Claim Form (WageWorks)
- Verizon Wireless Discount Information
- Sprint Discount Information
Payroll Forms
- VA-4 State Taxes
- W-4 Federal Taxes
- I-9 Employment Eligibility Verification
- Payroll Distribution Form
- FLEXCOMP Explanation
- 403(b) Salary Reduction Agreement
- 457 Deferred Compensation Plan
- Prior Service Buy-Back Agreement: see Payroll Coordinator
Retirees’ Forms and Information
- Retirement Checklist
- Retirement Resignation Form
- Application for VRS Retirement
- Application for VRS Disability Retirement
- Request for VRS Defined Benefit Plan Refund
- Request for VRS Income Tax Witholding
- Authorization for VRS Direct Deposit
- Request for VRS Health Insurance Credit
- Request for Retirement Sick Leave Payout
- Virginia Retirement System Life Insurance Overview
- Designation of Beneficiary
Retirement Planning and Savings
- 457 Deferred Compensation through VRS
- 403(b) Tax-Sheltered Account Information
- Prior Service Buy-Back Agreement: see Payroll Coordinator
- Request for VRS Estimate of Retirement Benefits
Wellness Program Forms
- Employee Assistance Program through the University of Virginia (a free, confidential resource to help address personal issues)
- Health Club Access
- YMCA Enrollment Form — YMCA Is our newest partner in fitness! To join, complete form before the next open enrollment date, 10/1/2018.
- ACAC Fitness Center Enrollment Form
- Smith Aquatic & Fitness Center Enrollment Form
- Fitness Cancellation Form
- Hike/Bike Incentive
- “Connecting Communities” City-County Employee 5K Walk/Run