Vanderbilt University PostdoctoralTrainee
2016-2017 Benefits Action Form(BAF)
DIRECTIONS
Use this form for VU or VUMC Postdoctoral Research Trainees. Send completed forms by the 15th of the monthto:
For VU Research Fellow Trainees:

Irene McKirgan, Program Manager, Office of Postdoctoral Affairs, Graduate School, 117 Alumni Hall:

For VUMCResearchFellowTrainees:

AmyGrubb, BenefitsRepresentative,VanderbiltUniversityMedicalCenterHR:
IMPORTANT
VUMC RESEARCH FELLOW TRAINEES
VUMC BAF Deadline
BAFsaretobereceivedbythe15thofthemonthforchangetobeeffectivethefollowingmonth.ABAFreceivedafterthe15thofeachmonth will resultintheresponsibledepartmentcompletingaJournalEntry(JE)inordertoassignchargestoappropriatecenternumbersorreversecharges,dependingontherequestedaction.
VUMC Enrollment
  • The trainee must enroll online within 31 days of their effective start date. If they fail to enroll within the initial open enrollment period, they will default into waiving the insurance and will not be eligible to enroll again until the next open enrollment period.
  • Once the trainee enrolls online, the enrollment form will be sent to Amy Grubb for verification. The trainee’s enrollment will not be verified until a BAF has been received from the department. No trainee will be enrolled until the online enrollment form and the BAF have been completed.
VUMC Termination
In order to terminate a trainee from the insurance, complete a new BAF with the action to terminate and list the termination effectivedate. Center numbers willcontinueto be charged untilaterminationBAFisreceived.
VU RESEARCH FELLOW TRAINEES
VU BAF Deadline
BAFsaretobereceivedbythe15thofthemonthfor new trainees that will be enrolled. ABAFreceivedafterthe15thofeachmonth will resultintheresponsibledepartmentcompletingaJournalEntry(JE)inordertoassignchargestoappropriatecenternumbersorreversecharges,dependingontherequestedaction
VU Enrollment
  • The trainee must enroll online within 31 days of their effective start date. If the trainee fails to submit an online waiver form, they will default into insurance coverage and will not be able to enroll again until the next enrollment period.
VU Termination
In order to terminate a trainee from the insurance, complete a new BAF with the action to terminate and list the termination effectivedate. Note: termination dates are: December 31, April 30, May 30 and August 11. Center numbers willcontinueto be charged untilaterminationBAFisreceived.
Section 1: Trainee Information Section 2: Department Information
First Name / HomeDepartment of Trainee
Middle Name / Staff Responsible for BAF
Last Name / PhoneNumber for Responsible BAF
Home Address
Employee ID (7 digit #)
Date of Birth
Gender
Phone (Optional)

Section3:BenefitsActionInformation

Action:Usethedropdownmenutoselectwhatactionistakingplace:

NewEnrollee,CenterNumberChange,TerminateCoverage,Other.

Effective Date:Entertheeffectivestartdatethattheactionaboveistakingplace.

Funding Source:Enterthetrainee'sfundingsource.

Forexample,ifthetraineeisbeingfundedbyatraininggrant,

youwouldenterthetraininggrantIDnumber.

Comments:Use thecommentssectiontoclarifyanyinformationontheform.

Section 3: Benefits Action Information
Action
Effective Date
Funding Source
(e.g., T32 DK001234)
Comments
Section 4: Distribution Information
AccountNumber / CenterNumber / % orAmount
64430
64430
64430
Section 5: ApprovalSignatures of Individuals Authorized to Sign for Each Center Number Listed Above
Signature/Date: / Signature/Date:
Signature/Date: / Signature/Date:
Signature/Date: / Signature/Date:
Signature/Date: / Signature/Date: