Human Resources / Enrollment/Change Forms

The District utilizes various forms pertaining to the healthcare benefits (medical, prescription, dental). If you have a question regarding the Enrollment/Change forms, please contact Eileen Seichepine in the Human Resources Department at 610-892-3470 extension 1406 or at eseichepine@wssd.org.

IBC (medical) Enrollment/Change Form

CVS/Caremark Prescription Enrollment/Change F orm

United Concordia Dental Enrollment/Change Form

Disenrollment from Healthcare Benefits Form - only completed electronically - click here for directions

WSESPA, Confidentials, Teamsters Voluntary Short-Term Disability Form <
WSEA Voluntary Disability Form

Vision Enrollment Form