• Qualifying Life Event (QLE): HR must be notified within 30 days of the Qualifying Event, and proof is required; email supporting documentation to [email protected].
•  If you opt out of medical, you are eligible for the medical waiver. After completing your enrollment process, a copy of your insurance card must be submitted to HR at [email protected] before the end of the month.
• Name changes must be sent to HR at [email protected].

New Dependent documentation must be submitted to HR at [email protected] after completing your enrollment elections: a Marriage Certificate or Divorce Decree, Court orders requiring coverage, a Birth certificate for the child(ren), and Social Security cards for all new dependents. (Domestic Partners are not eligible.)

Forms can be found under the Additional Employee Resources tile; scroll down the page to see this tile.

Please scroll down to review your Plan Benefits before connecting with a Benefit Counselor through the Call Center.

Starting July 1st, your Rx Pharmacy plan will be administered through CVS Caremark.

The Madison National Life Insurance Company requires Evidence of Insurability (EOI) for the following benefits: 

• Voluntary Group Life: Only new hires who enroll under $50k are not required to complete an EOI. An EOI will be required for coverage over $50k. Previously eligible employees will be required to complete an EOI regardless of the amount of coverage. It must be submitted directly to the carrier within 60 days of your enrollment process.
• Long-Term Disability: Only new hires who enroll in the first 31 days of employment will be eligible to enroll without completing an EOI.
• Mail your application to National Insurance Services, 300 North Corporate Drive, Suite 300, Brookfield, WI 53045, Attention: Billing Department.
• Group # 027774, Upper Dublin School District.

Click Here to download/complete the Evidence of Insurability (EOI) Form.