TTU Benefits - Initial Enrollment (Insurance)

Enroll in Group Benefits Plan (Faculty, Staff and Graduate Students)

In this step, you will complete the Insurance Multipurpose Form.

If you choose not to enroll in the health and optional coverage, you do not need to complete the Multipurpose Form.

The Step 2 involves completing the Insurance Multipurpose Form. The Form is divided into six sections, namely - Section A, B, C, D, E, and F. Following the instructions on these pages will help you complete the Insurance Multipurpose Form. You can complete the Form online and then print it onto your printer. A Form completed online is more legible and easy to understand.

Step 2 on these pages has been sub-divided into three steps: Step 2-a, Step 2-b, and Step 2-c. At the end of Step 2-c, you would have completed the Insurance Multipurpose Form and printed it. This printed Form along with rest of your Forms and Documents will have to go to HRS - Employee Service Center in Drane Hall in Room 135.

There is a limited 31-day enrollment period for optional insurance coverage.

Download the Insurance Enrollment Form. Click on the link and save the file to the hard disk on your computer. Open the downloaded Form and complete it by typing-in the fields. Keep saving regularly. Turn in the completed Form to the benefits department by printing it (after completion).

Section A - Employee Data

	National ID/SSN - Enter your Social Security Number here.
	EmpID - The downloaded Form should have 'N/A' typed-in, leave it as it is (don't fill).
	Effective Date - Leave it blank. This date will depend on the date your completed documents reach the benefits department and the 'First Active Duty Date.' Effective dates are set separately for Medical Coverage and Optional Coverage. Use the Online Calculator to calculate your effective dates. Do not fill this date, the calculator is for your reference only.
	First Active Duty Date- Fill-in your date of Hire/Employment by Texas Tech University.
	'Check if new address' check box - Leave it unchecked.
	Fill-in your personal details like Employee Name, Gender, Birth Date, Mailing Address, Telephone Number and E-Mail Address.
	Insurance Pay rate - Enter your monthly salary.
	Change Employee Name - Type N/A.
	Change BirthDate - Type N/A.
	Employee previously covered under Natl. ID/SSN - Type N/A.
	Employee under Natl. ID/SSN correction - Type N/A.
	Agency Name - The downloaded Form should have 'Texas Tech University' typed-in, leave it as it is (don't fill).
	DeptID - The downloaded Form should have '0733' typed-in, leave it as it is (don't fill).
	Employee Class - Leave blank.

Section B - Action Code

As a new Employee, only the first two check boxes are relevant for you. Check the appropriate box - check 'New Hire,' if you are a 'New Hire' and 'Rehire,' if you are being 'rehired.'

Section C - Qualifying Life Event

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