TBA 2025 Employer Elections

2026 Renewal: Employer Elections

*Indicates a response is required
Business Name:*
DBA:
Eligibility: The firm or law office and all attorneys in the firm or law office, must be members of the Tennessee Bar Association. Sole proprietors must have at least one W-2 employee working a minimum of 30 hours per week to participate.
Eligibility Certification:*

Eligibility requirements are met.
2026 Open Enrollment Elections - Effective January 1, 2026
Eligibility Requirement - Minimum Hours Worked:

Employees must work a minimum of 30 hours to be eligible for benefits.
Eligibility Requirement - Waiting Period*

First of Month following Date of HireFirst of Month following 30 daysFirst of Month following 60 days
Medical: You may choose to offer one or more of the medical plan options to all of your benefits-eligible employees.*

Option 1Option 2Option 3Option 4
Dental:*

Renew with dental.Renew without dental.
Vision:*

Renew with vision.Renew without vision.
Companion Life:

All medical plans include $15,000 of Basic Life Insurance at a cost of $3.00 per employee per month. It is the Employer's responsibility to retain completed and signed Basic Life Enrollment Forms containing beneficiary information.
Voluntary Life:*

Renew with voluntary life.Renew without voluntary life.
TBA Health Benefits Trust Portal Authorization and Access*

The undersigned employer acknowledges that state and federal privacy and data security laws protect employee information and will authorize access to the TBA Health Benefits Trust Portal only to employees who would otherwise have reason to view and maintain employee and employer information by virtue of their role. Such access is limited to performing functions specific to the administration of the employer's benefit plans. The undersigned acknowledges it is the employer's responsibility to notify Member Services at tba@assoc-admin.com of any changes in employees with authorized access. The undersigned acknowledges that the employer is responsible for maintaining accurate employee and dependent information on the TBA Health Benefits Trust Portal and that failure to do so may result in billing errors and loss of coverage. The responsibility for maintaining employee and dependent information includes collecting and storing enrollment and beneficiary forms.
Acknowledgement:*

I have read, understand, and agree to the statements above. I have the authority to approve binding agreements on behalf of my firm.
Authorized Signer:*
Name and Title:*
Date:*
Email*
example@example.com
Should be Empty:

2026 Renewal: Employer Elections

2026 Open Enrollment Elections - Effective January 1, 2026