This document provides a retirement checklist for employees planning to retire from UT Health. It outlines several important steps to take, including contacting benefits representatives and retirement providers, enrolling in health and other insurance benefits as a retiree, and applying for retirement and Medicare if eligible. Key actions are to schedule an appointment with benefits staff at least 6 months before retiring, submit required forms and documentation for retiree health benefits within 31 days of retiring, and contact retirement providers 3-6 months before retiring to discuss distribution options.

1. RETIREMENT CHECKLIST
Please use the checklist below to plan what we hope will be a smooth transition to retirement. If you are a TRS
member, contact TRS at least six months prior to your retirement date.
 Learn about the eligibility requirements to retire with benefits and coverage options available if eligible.
 Visit the UT System Office of Employee Benefits website: http://www.utsystem.edu/benefits/retirees/
 Read the benefits handbook for retirees: http://www.utsystem.edu/benefits/pubs/2013RetHandbook.pdf
 Call 713-500-3935 to schedule an appointment with a benefits representative
 Use the Retiree Rate Sheet to calculate your monthly out-of-pocket cost for retiree health benefits.
 Complete and return the following to the UT Health benefits office preferably prior to your retirement date
but no later than 31 days after your retirement date.
 UT Benefits Enrollment/Change Application to enroll in benefits as a retiree
 Dependent Information for UT Benefits Coverage Form and documentation required by Dependent
Documentation Chart to enroll eligible dependents
 Declaration of Tobacco Use or Non-Tobacco Use Form if enrolled in the medical plan
 Beneficiary Designation Form for Group Term Life & AD&D
 Authorization Agreement for Direct Debit Form to allow UT to withdraw your retiree insurance
premiums from your bank account every month
 Retiree Information Form to provide your personal information and two emergency contacts
 Optional Retirement Program Declaration of Retirement Form for ORP participants only
 Copy of Application for Service Retirement Form (TRS 30) for TRS participants only
 Vacation Payout Form to let payroll know how you wish to be paid for your unused vacation hours
Purchase/Change Agreement Form to defer any portion of your unused vacation leave into the UT
Saver 457(b) Deferred Compensation plan up to the annual contribution limit
 Sick Leave Pool Donation Form to donate unused sick leave hours to the sick leave pool
 Compliance Form if you have no rule or regulation violations to report sign and date form
Submit forms and documentation in person, by fax: 713-500-0342 or email: benefits@uth.tmc.edu.
 Contact CNA at 888-825-0353 to set up direct billing for Long Term Care if enrolled within 31 days from
your retirement date. See enclosed contact list (Insurance Plan- Customer Service & Group Numbers)
 Contact Social Security to enroll in Medicare Part A and B if eligible for Medicare at least 2-3 months
before your retirement date (if age 65 or older). See documentation (UT Select Medical & Medicare).
 Contact your retirement provider or financial advisor 3-6 months before retirement to discuss distribution
options (for ORP, TSA, or DCP participants only).
 Contact TRS six months before retirement to request a retirement packet (for TRS members only). View
TRS checklist at http://www.trs.state.tx.us/benefits/documents/checklist_for_retiring_members.pdf
 Go to www.uthro.org to become a member of the U.T. Houston Retiree Organization (UTHRO).
For more information or questions, contact the benefits office at (713) 500-3935 or benefits@uth.tmc.edu.