Medical, Dental & Vision Enrollment
The State of TN Group Insurance Program Enrollment/Change Application must be completed, signed and dated, and submitted to Human Resources whether you choose to participate or not in the program.
Note: If you elect family coverage, you must provide dependent eligibility verification data. A list of acceptable verification documents can be found here.
- Enrollment MUST be completed within 31 days of our hire date
- Required dependent verification documents MUST also be submitted during this timeframe
- Applications will not be submitted for enrollment until all documents are complete and obtained
*Please note, PPO plans have pre-existing limitations; therefore, if you have had previous coverage within 60 days of your current plan’s start date, please provide the Certificate of Coverage letter that you should have received from your previous employer or insurance carrier to waive the pre-existing requirement.*
Click here for your
2014 Enrollment/Change Application
For plan comparisons, premiums and other insurance information, click
Please contact Pamela Trent, 615-743-7433 or firstname.lastname@example.org, before submitting ANY benefits forms to ensure that they are complete.
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