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.
• 2022 HSA Employee Contribution Form
• 2023 HSA Employee Contribution Form

Deferred Compensation

• 403(b) Participation Agreement
• 403(b) Termination Agreement
• 401K Enrollment Forms
  • 401(k) Enrollment Form - (for employees in the legacy plan only; new employees are auto-enrolled in this plan)
  • 401(k) Beneficiary Designation Form - for naming or changing your 401(k) beneficiary
  • 401(k) Participant Change Request (for name or address changes)
  • Empower (formerly Great West) has notified us that deductions or increases to contributions must be made online at www.gwrs.com or by calling their office at 1-800-922-7772.  If you have not accessed your account online previously, you will be required to call the toll-free number to obtain your PIN.
• 457b Enrollment:
  • To enroll in the 457b, 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 

Flexible Benefits

• Flexible Spending Account Reimbursement Claim

Beneficiary Changes

The beneficiary designation forms are below.  Please complete the forms for benefits in which you are enrolled.  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 the forms that apply to you, review your benefits through Employee Self-Service at OneStop or contact the Office of Human Resources at 7177 or 7181.

• 401(K)
• Basic Life and Accident: Please log in to your Edison account to update these beneficiaries
• Voluntary Accidental Death and Dismemberment
• Voluntary Term Life
• TCRS Retirement
• Designation of Beneficiary (Wages, Annual Leave, Sick Leave, Compensatory Time)
• TIAA
• VOYA