AY 2022/2023 PAYROLL DEDUCTION FORM & INT. GE WAIVER.

If you are a RETURNING GE WHO HAS PREVIOUSLY BEEN ON THE GTFF INSURANCE PLAN you NEED to fill this out to have your insurance continue/be reinstated starting fall term and to be waived out of the the UO’s International Student insurance plan (if you are an Int. GE).

This form allows you to: 1) pay your premiums via payroll deductions, 2) waive out of the UO’s int. student plan if you are international, 3) add a dependent that is/was not already on your plan.

Note: if you want to DROP someone currently on your plan, you need to email Glenn and let him know. benefits@gtff.net

To change your DENTAL plan, please use this form AFTER you fill out payroll form

If you are a NEW GE–OR NEVER BEEN ON THE GTFF INSURANCE–you need to FIRST fill out an enrollment application. This form will be part of that application. Do NOT fill this out yet!


GTFF PAYROLL DEDUCTION & INT. GE WAIVER FORM — AY 2022/2023