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All forms are fillable and ready for download and printing. VRS accepts all forms by mail or fax. Fax to: 804-786-9718. If on deadline when faxing a form, please call or email to alert VRS of its pending arrival. VRS does not accept forms via email, which is not a secure form of communication.

employer Health Insurance Credit Forms
Form #DescriptionLast UpdatedLink
VRS-45 Request for Health Insurance Credit
Retired participants who do not have premiums deducted from their VRS monthly benefit must complete this form.
01/2020 Download
VRS-75 Optional Retirement Plan Health Insurance Credit Employer Certification of Service
Completed by Optional Retirement Plan participants and by their employers, who certify employment.
01/2020 Download
VRS-76 Certification of Employment for Health Insurance Credit Eligibility
Completed only by employers certifying general registrars, local officers, employees of these referenced positions and local social service employees.
04/2019 Download
VRS-78 Authorization to Deduct Insurance Premiums
Completed only by employers for non-state participants.
04/2019 Download

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