Annual Enrollment Retirees and Families - Texas State University 2025

1. Click ‘Get Form’ to open the Annual Enrollment form in the editor.
2. Begin by filling out Section A with your personal data, including your member type (Retiree, Surviving Dependent, or COBRA) and contact information.
3. In Section B, indicate your desired insurance coverage changes. You can choose to enroll in HealthSelectSM of Texas or an HMO, or waive coverage if you have comparable insurance.
4. Complete Section C for dependent information. Ensure you provide accurate details for each dependent you wish to enroll or drop from coverage.
5. Review Section D for authorization. Sign and date the form to confirm that all information is correct and that you understand the terms.
6. Submit the completed form via mail or online through your account on our platform before the enrollment deadline.

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