Benefits Forms

Health Insurance

• Insurance Enrollment Change Application - Must be submitted within 30 days of a new dependent's acquire date or within 60 days of the loss of eligibility for other health insurance coverage.
• Insurance Cancel Request Form- Must be submitted within 60 days of a qualifying event.
• Voluntary Accidental Death and Dismemberment Enrollment —Plan Year 2024
• Voluntary Term Life Enrollment - Apply for or increase coverage and update beneficiaries on the Securian website.
• 2024 HSA Employee Contribution Form

Flexible Benefits

• Medical, Dependent Care and Limited Purpose —Plan Year 2024
• Family Status Change Application
• Optum Bank FSA claims form
  • File an online claim at https://www.optumbank.com/tennessee.html 

Deferred Compensation

• 403(b) Participation Agreement
• 403(b) Termination Agreement
• 401(k) Enrollment Forms
  • To enroll in or change 401(k) contribution, visit www.RetireReadyTN.gov
    • Select the Login to your 401(k)/457 accounts link, then click on the Register button.
  • Or call RetireReadyTN at 800-922-7772 between 8 a.m. and 7 p.m. CST 
  • Paper enrollment forms can be made available if you call 800-922-7772 
• 457(b) Enrollment:
  • To enroll in the 457(b)b, you can enroll online at www.RetireReadyTN.gov
    • Select the Login to your 401(k)/457 accounts link, then click on the Register button.
  • Or call RetireReadyTN at 800-922-7772 between 8 a.m. and 7 p.m. CST 
  • Paper enrollment forms can be made available if you call 800-922-7772 

Beneficiary Changes

The beneficiary designation links are listed below.  Please visit each link and log into your account to update beneficiaries. If you are enrolled in the ORP retirement option, please update your beneficiary at the website for the company to which your contributions are going—TIAA & VOYA; links below.  If you have questions regarding beneficiaries, contact the Office of Human Resources at 7177 or 7181.

• 401(k)/457(b): Login to your Self-Service account at www.RetireReadyTN.gov
• Basic Term Life, Basic Accidental Death and Dismemberment, and Voluntary Accidental Death and Dismemberment: Please log in to your Edison account to update these beneficiaries. Click the Self Service tab, Employee WorkCenter, Life Insurance Beneficiaries
• Voluntary Term Life: Log into Securian account at lifebenefits.com/statoftn
• TCRS Retirement: Log into your TCRS Self Service account at mytcrs.tn.gov 
• Designation of Beneficiary (Wages, Annual Leave, Sick Leave, Compensatory Time); Submit form to the Office of Human Resources
• TIAA: Log into your TIAA account
• VOYA: Log into your VOYA account