TUSCULUM COLLEGE > HUMAN RESOURCES > Open Enrollment 2017-2018


Open Enrollment 2017-2018

The open enrollment period for your 2017-2018 benefits will be from March 7, 2017, through March 17, 2017. Please turn in all forms to Human Resources by 5:00 pm on March 17, 2017.

Changes and Enhancements for 2017/2018:

Your Medical Coverage will remain with BlueCross BlueShield of TN.   You will have a choice between three plans effective April 1, 2017, the Core Plan, the Buy-Up Plan and a High Deductible Health Plan.  All three plans utilize Network S.  Please note that UT Medical Center and affiliated physicians will NO longer participate in Network S.

Tusculum College will be offering Voluntary Short Term Disability coverage through Guardian effective April 1, 2017.   Short Term Disability coverage can protect your income in the event of a short -term injury or illness.  You disability benefits begin on the 8th day that you have been disabled and is payable for a maximum of 26 weeks.   Once you have met this elimination period, you are eligible to receive 60% of your pre-disability monthly earnings not to exceed $1,000. Short-term Disability will no longer be available through AFLAC, however, you may continue your current STD coverage and payroll deduction with AFLAC.



You may email the forms to : tcbenefits@tusculum.edu

Anyone using Internet Explorer or Google Chrome can edit the HR forms with no problems.  If someone is using Firefox they will need to save (download) the form first and then edit it. 

Tusculum College Benefit Guide

  1. Tusculum Benefit Guide 2017

Tusculum College Benefit Election Form

  1. All full-time employees must fill out and sign this form.
  2. Benefit Election 2017-2018- (click to open)

Please remember 

  • If your spouse has coverage available to them through his or her employer, they will be considered ineligible under the Tusculum medical plan **Note: This change does not apply to Dental, Vision, Supplemental Life Insurance, Flex Spending, or AFLAC.
  • You must fill out the form below each year at open enrollment

 **Please click on the form name to open the form(s) below.

Anyone using Internet Explorer or Google Chrome can edit the HR forms with no problems.  If someone is using Firefox they will need to save (download) the form first and then edit it. 


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

Medical Information 

Medical Forms

  1. Medical Add_Change form
  2. Medical Enrollment form
  3. Medical Termination form
  4. GO-01-Certification of Dependency
  5. M-241 Domestic Partner Certification Form


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


Dental Forms 


Group #00498351
Website Address: https://www.guardiananytime.com/


  • Vision Benefit Summary
  • Vision Premiums 2017-2018
  • To find an in-network provider or surgery center, call customer service or go to www.guardiananytime.com and click on “Find a Provider,” select the Davis Vision plan, enter all desired information and click search.

Vision Forms 


Teledoc Information

Teledoc Forms

  1. Tusculum Teladoc Enrollment Form


Guardian Life Insurance

Group #00498351
Website Address: https://www.guardiananytime.com/


Forms – Life Insurance forms cannot be signed electronically

  1. Guardian Multiple Enrollment form (Basic Life, LTD, Voluntary Life,  Dental, Vision)
  2. Guardian Evidence of Insurability (EOI) The EOI  is required if you are electing or increasing coverage.
  3. Beneficiary Change Form GG17A

Guardian Short Term Disability (STD)

  1. STD Benefit Summary
  2. STD Enrollment form 2017


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

Benefits Assist, Inc.

Create and Access your Account



  1. 2017 – Section 125 – Election Agreement The FSA Election Agreement must be filled out each year in order to continue your FSA deduction.
  2. 2017 – Section 125 – FSA Employee Change Form  If you have any changes, such as marriage/divorce, birth/adoption, death, change of address, etc.
  3. 2017 – Section 125 – Manual Claim Form




  1. Available through Susie Thorpe 

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



Plan #337038-TIAA  RA

  1. At this time, you may only change the contribution percentage to your TIAA Defined Contribution Retirement Account. Eligible enrollments can only be made during the months of January and July.


  1. If you wish to change the percentage, please use the Salary Reduction Agreement Form for this change.
    1. Salary Reduction Agreement

Plan #337039-TIAA Supplemental

  1. To enroll online please click on the link below-
    1. www.tiaa.org/myretirementplan
    2. Tusculum College Enrollment Guide 337039 GSRA
    3. Use Plan ID 337039
  2. If you do not have access to a computer, you can still fill out paper forms, but they cannot be signed electronically.


    1. TIAA Personal Verification Information
    2. Supplemental Account Choices and Instructions
    3. Supplemental Enrollment Form
    4. Allocation Choices
    5. Account Choice Descriptions
    6. If you are enrolling for the first time, online or by paper, the Salary Reduction Agreement below must be submitted to Human Resources. Also, if you wish to change the percentage, please use the form below for this change
      1. Salary Reduction Agreement

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.org

Millennium Advisory Services


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

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.