Retiree Insurance

Office of Human Resources

UT Tyler Retiree Insurance Enrollment

• Your insurance will not automatically continue when you retire. You must complete and submit forms to the Human Resource Service Center (HRSC) no later than 31 days after your retirement date.
  • Retiree Insurance Benefit Overview.
  • Insurance Enrollment/Change for Retirees [PDF]
  • Tobacco Premium Program
  • Dependent Information [PDF] (Only if Adding a Dependent Not Previously Covered)
  • Automatic Payment Request Authorization [PDF] (Optional)
  • Copy of TRS 30, Application for Service Retirement (TRS Participants Only)
  • ORP Declaration of Retirement [PDF] (ORP Participants Only)

Group Term Life Conversion

• If you wish to convert coverage greater than $50,000 to an Individual Whole Life policy, please review the steps outlined in the Conversion Privileges section of the COBRA Web page. You must apply for conversion no later than 31 days after your retirement date.

Long-Term Care

• Contact CNA at 888.825.0353 no later than 31 days after your retirement date to request a direct billing to your home address.

Medicare Enrollment (Available at Age 65, or Younger if Due to a Disability)

• Contact the Social Security Administration (SSA) at least three months before you need benefits to begin. Enroll in Medicare Parts A and B online or phone 800.772.1213.

  If over age 65 when you apply, request forms CMS-40B and CMS-L564. Submit form CMS-L564 to the HRSC and allow 24-48 hours for completion.