Instructions for CDHP/HSA: HealthSavings Authorization Form
If you enrolled in the Wellness HealthSavings CDHP as your health insurance plan for 2016, in early January, the University of Tennessee will deposit the employer contribution of $500.00 for employees with individual coverage and $1,000 for employees with family coverage into your Health Savings Account.
If you enrolled in the Standard HealthSavings CDHP as your health insurance plan for 2016, and want to add your own monies to the Health Savings Account, please read the instructions below and complete the necessary form.
If you would like to sign up to have additional funds deducted pretax from your payroll checks and deposited into your Health Savings Account, a Health Savings Account Authorization form must be completed whenever you wish to start, stop, or change the amount during the year. Completed forms (keep a copy for your records) may be returned via:
- US Mail: University of Tennessee, Payroll Dept, P115 Andy Holt Tower, Knoxville, TN 37996
- Fax: 1-865-974-3530
- Deliver: UT Chattanooga, Human Resources, Dept 3603, 615 McCallie Ave, Chattanooga, TN 37403 (5 days prior to deadline below)
For monthly employees, the form will be due in the Payroll Office by the 15th of the month to be included in that month’s payroll. For biweekly employees, the form will be due in the Payroll Office by the last working day of the pay period to be included on that biweekly payroll.
Please note, if you signed up for the Wellness HealthSavings CDHP, and if you have a 2015 Medical Flexible Benefits Account with a balance on December 31, 2015, the Internal Revenue Service will not allow employer or employee contributions to your account until April 1, 2016.
If you have any questions in reference to UT payroll deductions, please call 1-865-974-5251. If you have questions about your Health Savings Account, please call Payflex/Healthub at 1-855-288-7345. Please note: This is not the same website and phone number associated with the Flexible Benefits Plans.
Regular full-time or regular part-time (75%+) appointments and eligible dependents may enroll in health insurance. The University pays 80% of the health insurance premium and the employee pays 20% (pre-tax). Coverage becomes effective on the first day of the month following completion of one full calendar month of employment if all necessary forms are received by the Office of Human Resources. Premiums are paid a month in advance.
Dependent Eligibility Verification Documents
Please refer to this list for documents required for dependent eligibility verification. Documentation required for dependents must accompany paperwork. The employee has 60 days to provide a Social Security number for newborns or other dependents. However, application for coverage to add new dependents must be made within 31 days of the birth or adoption date.
Transferring health insurance plans may be done only during Annual Enrollment. This is the only time of the year when participants can make changes in their insurance coverage. Changes in coverage will become effective on January 1.
Cancellation is not permitted outside of Annual Enrollment unless the covered person experience a qualifying event or family status change.
If you choose the Partnership PPO or Wellness Health Savings CDHP, you must commit to a Partnership Promise. Both you and your spouse, if enrolled, have to meet the Partnership Promise in order to remain in the selected plan. Children, regardless of age, do not have to fulfill the Partnership Promise. If you cannot fulfill the Partnership Promise because of a physical or mental health condition, your health coach will work with you to come up with a different way to keep your Promise.