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Benefits Office

600 Forbes Avenue
Pittsburgh, PA 15282
Email: benefits@duq.edu
Phone: 412.396.5106
Fax: 412.396.2236

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Benefit Forms

Recommended Schedule for Preventive Care for Children and Adults

Caremark Mail Order Prescription

Caremark Mail Order Prescription Guide

Caremark Making the Most of Your Prescription Benefit

Caremark Prior Authorization

Caremark Reimbursement

Change of Address

Cigna HIPPA Authorization Form

Cigna/JP Morgan Chase HSA Rollover Form

Cigna International Travel Emergency Coverage Information

Cigna Medical Claim

DBI Additional Debit Card Request

DBI Contribution Calculator

DBI Dependent Care Claim

DBI Direct Deposit

DBI Expense Eligibility Listing 2011

DBI Guide to Filing Claims

DBI Reimbursement Request

DBI Orthodontia Claim

DBI Over the Counter Guide

DBI Online Registration Directions

Highmark Medical Claim

Highmark/BNY Mellon HSA Distribution

Know Your Numbers Documentation and Directions

Life Insurance Change of Beneficiary

Qualified Life Event

Retirement Plan Salary Reduction Agreement

Wellness In Motion Log