Exempt Employee Benefits

Let's Get Started!

If you are NOT enrolling in health care, please complete these 3 forms then scan/email them to ptrent@tnstate.edu

  1. Enrollment Form   (select REFUSE)
  2. Life Insurance Beneficiary Form (beneficiary should be age 18 or older)
  3. Designation of Beneficiary Form (must be notarized prior to scanning/emailing)

You are done!  Please close all of the open browsers and scan/email all forms to ptrent@tnstate.edu

To Enroll in health care:  Please read all of the instructions to avoid a delay in coverage.

INSTRUCTIONS:  You have 31 days from your date of hire (which may be different from the date in which you signed your contract) to enroll in health care.  This includes weekends and holidays.  Complete the fillable PDFs and print them so you can sign them.  You must scan/email all paperwork to ptrent@tnstate.edu within 31 days of your date of hire.  If you do not enroll within 31 days of your hire date, you will have to wait until the 2018 Annual Enrollment Transfer Period (AETP) and your coverage will begin 1/1/2019.

To see the available plans, please review the Enrollment & Eligibility guide (includes plans and premium costs)

Please complete and return the following forms within 31 days of your date of hire to ptrent@tnstate.edu :

  1. Enrollment Form (if you are adding dependents, review page 2)
  2. Life Insurance Beneficiary Form (beneficiary should be age 18 or older)
  3. Designation of Beneficiary Form (must be notarized prior to scanning/emailing)

You are done!  Please close all of the open browsers and scan/email all forms to ptrent@tnstate.edu  

Optional Coverage - If you are interested in additional information or optional coverage, please see below.

The videos below help illustrate the available plans.  PLEASE don't try to enroll using Edison, as the videos instruct, because Higher Ed does not use Edison for enrollment purposes.  Remember to close the video after watching.  You'll need to return to this screen to complete your enrollment.  DO NOT USE EDISON.

 

Acknowledgment

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