TUSCULUM COLLEGE > HUMAN RESOURCES > Open Enrollment 2014-2015

HUMAN RESOURCES


Open Enrollment 2014-2015

The open enrollment period for your 2014-2015 benefits will be from March 7, 2014 through March 28, 2014.

2014 Tusculum Benefits Guide 

*Note: You may want to print out a copy of the guide to follow along with each video.

Benefit Election Form 2014-2015  – Print this form – All full-time employees must fill out and sign this form.
Please remember to complete the survey at the bottom of this page. 
Changes and Enhancements:
  • Changed to Guardian Life Insurance Company for Life Insurance, LTD, and Employee Assistance Program
  • Changes to the Medical Coverage Effective April 1, 2014
    • Option 1 – Buy up Plan
      • Continued with Network P
      • Added a prescription drug out of pocket maximum of $2,850.  All prescription drug copays apply to this amount.  Required by ACA
      • Eliminated the Pre-existing provision
      • Office visit copays and deductible will apply to the medical out of pocket maximum
    • Option 2 – Core Plan
      • Changed from Network P to Network S
      • Added a prescription drug out of pocket maximum of $2,350.  All prescription drug copays apply to this amount.  Required by ACA
      • Eliminated the Pre-existing provision
      • Office visit copays and deductible will apply to the medical out of pocket maximum
MEDICAL

Blue Cross Blue Shield of Tennessee – Group #120156
Website Address: https://www.bcbst.com/

Information

Form ADC-13: Enrollment Change Form. Use for making changes/additions to a current member’s coverage. The member must sign the application for any changes.

Form EEW-13: Group Member Enrollment Form. Use for enrolling a new member in a group.

  • Signature rules for EEW:
    • If the member is electing coverage (Medical, Dental), they would complete the signature on the front of the application.
    • If the member is declining coverage, they would complete the signature on the back of the application.
    • If the member is electing one coverage and declining another, both signatures would be required.
  • EEW-13 Medical - Enrollment/Waiver Form

Form GO-01: Group Member certification for non-biological dependent (i.e. adopted, legal guardian/legal custody, step-child).

Form M-241: Group Member certification for domestic partner

Form TRM-09: Termination Form. Use to terminate members with or without electing COBRA coverage.

Vision Information (Only available with Option 1 medical)

DENTAL

Blue Cross Blue Shield of Tennessee – Group #123347
Website Address: https://www.bcbst.com/

Information

Form ADC-13: Enrollment Change Form. Use for making changes/additions to a current member’s coverage. The member must sign the application for any changes.

Form EEW-13: Group Member Enrollment Form. Use for enrolling a new member in a group.

  • Signature rules for EEW:
    • If the member is electing coverage (Medical, Dental), they would complete the signature on the front of the application.
    • If the member is declining coverage, they would complete the signature on the back of the application.
    • If the member is electing one coverage and declining another, both signatures would be required.
  • EEW-13 Dental - Enrollment/Waiver Form

Form GO-01: Group Member certification for non-biological dependent (i.e. adopted, legal guardian/legal custody, step-child).

Form M-241: Group Member certification for domestic partner

Form TRM-09: Termination Form. Use to terminate members with or without electing COBRA coverage.

Tips For Completing Forms

Submitting incomplete forms causes processing delays. The following tips should help ensure a smooth, automated enrollment process.

  • Please use your legal name, not what you are called.
  • Please complete all applicable fields on the form. Do not line through or use “N/A” in fields that are not applicable. Leave those fields blank.
  • Certain fields are required for processing. These are:
    • Group Number
      • Medical – 120156
      • Dental – 123347
    • Group Name
      • Tusculum College
    • Employee/Dependent Name(s)
    • Date(s) of Birth
    • Social Security Number
    • Gender
    • Coverage Information
  • Carefully follow the instructions provided with the form(s).
  • Black or blue ink is preferred. Do not use red ink or pencil.
  • Clearly print inside individual boxes.
  • Use the month, day and full year (for example, 07172001 for July 17, 2001).
  • Punctuation marks such as periods, commas, or dollar signs should not be used.
  • A dash should only be used in a name if it is actually part of the legal name.
  • After completing the form, review it carefully to assure all applicable fields were completed accurately.
  • If there are more dependents than are allowed on the form, use another enrollment form. Complete the dependent section only and attach it to the initial form.

Please do not write notes on the forms. Use a separate sheet of paper to relay any information

LIFE INSURANCE (Basic and Voluntary) & Long Term Disability(LTD)

Guardian Life Insurance
Group #00498351
Website Address: https://www.guardianlife.com/

Information

This form is required if you currently have the basic and voluntary life. (At this time Human Resources is unable to go through each file and let everyone know who they have listed as their beneficiary, therefore if you cannot remember your beneficiaries you will need to list new ones.)

This form is required if you are electing coverage for the first time or changing the amount of coverage and the amount of coverage is above the guaranteed issue amount of $150,000.00.

FLEX SPENDING

Benefits Assist, Inc.

Create and Access your Account

Information

The FSA Election Agreement must be filled out each year in order to continue your FSA deduction.

This form is required if there you have any changes, such as marriage/divorce, birth/adoption, death, change of address, etc.

This form is for manual claims

AFLAC VOLUNTARY PRODUCTS

 

Information

Representative Contact Information
Susie Thorpe
Phone: (865) 207-4311
Fax: (865) 694-0176
Email: jthorpe@bellsouth.net

RETIREMENT

TIAA-CREF

Forms

*Note: At this time, you may only change the contribution percentage to your TIAA-CREF Defined Contribution Retirement Account. If you wish to change the percentage, please use the Salary Reduction Agreement Form for this change.

Representative Contact Information

John Reeder, CFP®
Financial Consultant

800 S. Gay Street, Suite 700
Knoxville, TN 37929-9703
Phone: (865) 766-4025
Email: jreeder@tiaa-cref.org

Millennium Advisory Services

Information

Representative Contact Information

Steven Fenner
Investment Advisor Representative

5340 Twin Hickory Road
Glen Allen, VA 23059
Phone: (804) 346-1040
Toll Free: (877) 435-2489
Email: sfenner@mcmva.com

Survey

We want to hear from you! Please take a survey about the online open enrollment process.
START SURVEY »

Please remember that submitting incomplete forms causes processing delays. Please make sure that all forms are filled out completely and signed to ensure a smooth, automated enrollment process.

Since we are transitioning to Colleague for payroll, we are asking that all employees hired prior to 2014 fill out a new W-4 for 2014.  Please turn in the W-4  along with your open enrollment forms. Thank you for your cooperation.

  • 2014 – W-4 Form -   (At this time Human Resources is unable to go through each file and let everyone know what they have listed on their current W-4, therefore if you cannot remember please refer to the W-4 worksheet.)