Non-Exempt Employee Benefits Enrollment

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) (Complete Parts 2 & 8, sign/date the form)
  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: 

INSTRUCTIONS

  • You have 30-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 may ** scan/email all paperwork to ptrent@tnstate.edu 
  • If you do not enroll within this timeframe, you will have to wait until the Annual Enrollment period in the fall to enroll.  Your coverage will begin 1/1/2023.

To see the available plans and premiums, please review the Eligibility and Enrollment Guide

1.  Enrollment Form  (if you are adding dependents, review page 2.   These documents must be submitted with the Enrollment form). 

2.  Long Term Disability - Level 1 / Level 2 / Level 3  

3.  Life Insurance Beneficiary Form (beneficiary(ies) should be age 18 or older)

4.  Designation of Beneficiary Form (must be notarized prior to submitting)

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 advise, 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 !!!

** Due to the COVID-19 pandemic, our offices are closed.  All paperwork must be submitted via email.  Email is, by default, an insecure way of transmitting sensitive data and not recommended. If you decide to send your forms via email, be sure to delete the message from your “sent mail” folder after delivery. We also encourage you to employ email encryption options, if offered by your email provider.