Forms

Enrollment for most St. Jude benefits—including all Open Enrollment updates—is handled through MYBenefits. (There are no more paper forms for Open Enrollment.) Please log in with your St. Jude ID and password. 

If you have questions about MYBenefits or the forms below, please contact a member of the Human Resources-Benefits team at 595-4502.

Medical, Prescription Drug, Dental and Vision Plans

• Medical Claims Form – BlueCross
• Vision Claim Form
• Caremark Mail Order Prescription Form
• Caremark-Brand Penalty Exception Form

Retirement Plan

• TIAA's Online Enrollment Form

Leave Programs

• Leave of Absence Request Form
• Certification of Health Care Provider Form

Flexible Spending Account

• FSA Health Care Claim Form
• FSA Dependent Care Claim Form