1. NEW EMPLOYEE BENEFITS ENROLLMENT CHECKLIST
Welcome to the University of Texas Health Science Center at Houston. As a new employee, you have 31 days
from your first day of employment to enroll in benefits.
If you are full-time benefits eligible (appointed to work 40 hours per week for at least 4 ½ months), you will
automatically be enrolled in the Basic Coverage Package if you do not enroll in benefits within 31 days of
employment.
If you are part-time benefits eligible (appointed to work at least 20 but less than 40 hours per week for at least 4
½ months), you will have no coverage if you do not enroll in benefits within 31 days of employment.
 Be sure to download, read and print a copy of the following documents:
 Summary of Faculty Benefits:
 UT Benefits Handbook for Employees: http://www.utsystem.edu/documents/docs/benefits-handbooks-and-cost-
worksheet/ut-benefits-handbook-employees-2014-2015
 Overview of TRS and ORP: http://www.utsystem.edu/documents/docs/ut-retirement-program/overview-trs-and-orp
 UT Retirement Plan Providers: http://www.utsystem.edu/offices/employee-benefits/approved-providers
 Use the Faculty Rate Sheet to calculate your monthly out-of-pocket cost for benefits.
 Complete and return the following to the benefits office within 31 days of employment.
 UT Benefits Enrollment/Change Application
 Documentation to enroll eligible dependents
 Dearborn National Beneficiary Designation Form for Basic Life & AD&D
 The Standard Beneficiary Designation Form for Supplemental Life & AD&D
 ORP Acknowledgement Form
Submit forms and documentation by fax: 713-500-0342 or email: benefits@uth.tmc.edu.
 Complete and return the following to the address on the form within 31 days of employment.
 Evidence of Insurability Form if applying for more than 1.5 million in life insurance
 Long Term Care Enrollment Form if enrolling in long term care
 Complete and return the following to the benefits office within 90 days of employment if enrolling in ORP.
 ORP Authorization for Reduction for Employee Contribution Form
 TRS Form 28 (Election to Participate in Optional Retirement Program and/or Refund)
Note: You must log on to UT Retirement Manager to select a vendor and set up an account for ORP.
 Log on to UT Retirement Manager to enroll in a voluntary retirement savings plan at any time.
 Log in to Employee Self Service after your benefits effective date to be sure your coverage is correct.
The effective date of medical coverage for new hires is the 1st
of the month following 30 days of employment.
Based on when your paperwork is received by the benefits office, your optional benefits may be effective on: 1)
Your first day of employment; 2) The first of the month following your first day of employment; or 3) The first
of the month following your date of election.
For more information or questions, contact the benefits office at (713) 500-3935 or benefits@uth.tmc.edu.