Open Enrollment

After your initial election of medical and dental options, TBT’s Open Enrollment policy allows you to change your medical and/or dental options once every 12 months between January 1 and December 31.

How to Change Your Medical and Dental Option

You must use the forms below to change your medical and/or dental options. Otherwise, your current coverage continues without change.

Changing Medical Options: Contact the TBT Plan Administration Office to confirm your eligibility to change your medical option. See the Comparison of Medical Benefits for your TBT Plan. Note: If changing to an HMO, an HMO application is also required. Contact the TBT Plan Administration Office to request materials for HMOs available where you live.

Medical Option Change Form:  Participant (PDF) | Retiree (PDF)

Changing Dental Options: Contact the TBT Plan Administration Office to confirm your eligibility to change your dental option. Some restrictions apply. Be sure to check the Comparison of Dental Benefits for your TBT Plan.

Dental Option Change Form: Participant or Retiree (PDF)

Effective Date of Changes
Open enrollment change requests submitted on the approved medical or dental change forms will be effective the first day of the second month after the change request is received.
For example, if your change form is received on September 17, the change will be effective November 1. This assumes that all the required forms have been submitted and you are eligible for benefits.

IF YOU ARE CHANGING YOUR MEDICAL OR DENTAL OPTION, DO NOT ASSUME THAT YOU ARE ENROLLED IN YOUR NEW COVERAGE UNTIL YOU RECEIVE CONFIRMATION. Contact the TBT Plan Administration Office to confirm that your new coverage is in effect before using your benefits.

Unless you make changes, your current medical and dental options will remain in effect.

How to Request Medical/Dental Information

If you are thinking about making a change, use one of the forms below to request more information about your Plan’s medical and/or dental options:

Medical / Dental Option Information Order Form (PDF) (for Plans I, I-85, I-A, III, III-A, IV, V, V-A and the Retirement Security Plan)

Medical / Dental Option Information Order Form (PDF) (for Plan VI only)

Medical / Dental Option Information Order Form (PDF) (for the Comprehensive Retiree Plan only)