Upper Dublin Benefits
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Additional Employee Resources

  • After completing your benefit elections: Review and Submit your benefit elections with your PIN to ensure you are completed for the 2026-2027 plan year.
  • You can modify your benefit elections only during Open Enrollment or if you experience a Life Event.
  • During Open Enrollment, go to CHUBB-Benselect to review your current beneficiary info. Your beneficiary listed in the system will be used at claim time for the payout of the death benefit.
  • If you opt out of a Medical Plan, you must email a copy of your insurance card to HR at[email protected].
  • Medical FSA & Dependent Care FSA DO NOT roll over and must be re-elected individually every year.
  • If you are adding a NEW dependent, email the following documentation to HR after completing your enrollment at [email protected]: Marriage Certificate /Divorce Decree, Birth certificate for child(ren), Court orders requiring coverage, and Social Security cards for all NEW (Domestic partners are ineligible).
The Evidence of Insurability Forms (EOI) must be submitted to the carrier directly within 30 days of enrollment; otherwise, coverage will NOT be issued

Plan Features

Everything You’ll Need to Know

📌Qualifying Life Event (QLE): HR must be notified within 30 days of the Qualifying Event, and proof is required within 30 days of the event; email supporting documentation to [email protected]: 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.)

📌 If you opt out of medical, you are eligible for the medical waiver. Email a copy of your insurance card to Jenny Mossholder at [email protected]. Medical Waiver– If spouses work for Upper Dublin, only one spouse will enroll in Medical, Rx, Dental, and Vision; the other must WAIVE. The other spouse is not eligible for the medical WAIVER; The amounts are different depending on the bargaining unit. They receive the WAIVER payment in their biweekly paychecks over 21 pay periods. Employees must provide Jenny Mossholder with a copy of their insurance card after completing the enrollment process via email to [email protected].

📌Name changes must be sent to HR at [email protected].

📌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.

A digital assistance tool, ALEX, is available to help with medical plan comparison and can be accessed at this link: https://start.myalex.com/bmcs/upperdublin. ALEX will provide a comparison of the total costs of each available plan. The total cost includes your employee contributions and estimates of your out-of-pocket expenses. You will be able to run as many scenarios as you like – in just minutes!

Contact Human Resources, Jenny Mossholder, Benefits Specialist, at [email protected] or contact her at 215-643-8806

 

Plan Documents

Madison National Life Insurance Co - EOI

Evidence of Insurability Form -

Madison National Life Insurance Co

Insurance Benefit Enrollment Form

Madison National Life Insurance Co - Employer's Statement of Claim for Benefits

Claim Form - Disability Benefits

Madison National Life Insurance Co - Employer's Statement of Claim for Benefits

Claim Form - Disability Benefits

Madison National Life Insurance Co: Beneficiary Form

Declaration Form

Employee Assistance Program

EAP Flyer

UDSD Carrier's Contact Information

Websites

National Insurance Service EAP

Login: NISEAP | Password: EAP (Note: Password Is Case-Sensitive)

Contacts

National Insurance Service EAP - Customer Line

866.472.2734

HR Fax Number   

215.643.8808

Madison National Life Insurance Co - Customer Line

800.356.9601 Extension 2410

Mail: P.O. BOX 2865 CLINTON, IA 52733-2865