Human Resources >
Enrollment Change form graphic
 
 

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 Form
 
United Concordia Dental Enrollment/Change Form 
   
Disenrollment from Healthcare Benefits Form

FSA 2016 Plan Year Enrollment Form (19 pays)
 
FSA 2016 Plan Year Enrollment Form (26 pays)
 

 
 
 
 
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