University of Texas System - Office of Employee Benefits

Enrollment Tools

Logon to My Benefits to enroll, update, or view your benefits coverage using UT Touch Online.

Benefits Cost Worksheet

This is NOT an enrollment form. This worksheet is intended to assist you in estimating your out-of-pocket cost for benefits. It is valid for active employees and retired employees only, and does not include supplemental premium sharing offered by individual UT institutions.

Please remember this form only provides you (the subscriber) with an estimate of your total out-of-pocket cost per month based on state-appropriated funds and contracted premium rates. Be sure to review available benefits information and provider directories for more information on the plans listed.

Evidence of Insurability may be required to enroll in some of these coverages. For details, see your UT Group Benefits Handbook or contact your Campus Benefit Office.