Dcps Event Insurance Form

I understand that if i desire to apply for medical insurance at a later date i may enroll only during an annual enrollment period determined by m dcps or during a special enrollment period change in status following an irs acceptable change in status event.

Dcps event insurance form. Print name signature date. All employees are eligible for dental and vision options outlined. Shared by mleppin in registration forms. This flyer has been designed to illustrate the highlights of this insurance.

Retain this description for your records. Medicaid private insurance none. To choose the plan that fits you best you may review the health benefits plan summary. Dcps notifications of student and parent guardian rights.

Delaware county professional services dcps features over 50 therapists and psychiatrists providing a variety of therapy services throughout pennsylvania. Dcps has policies and procedures in place to protect its employees students and anyone associated with the district from discrimination harassment sexual harassment or retaliation. I give permission to the signing health examiner facility to share the health information on this form with my child s school child care camp or appropriate dc government agency. Vietnamese tiếng việt dc health and oral forms immunization requirements universal health form oral form dcps medication plan procedure form if applicable dc health asthma action plan if applicable.

Emergency contact and health insurance information parental permission for emergency treatment and release of liability. All student accident insurance information is subject to the provisions of policy form b33mp. Here is an event registration form that will allow you to accept registrations from someone for your fix events at the. All dcps employees receive basic term life insurance coverage beginning on day 1 of their employment and are automatically enrolled in this benefit unless they decline the coverage via peoplesoft during their first 31 days of employment.

The following district health benefits pertain to employees hired on or after october 1 1987. The cost of your health insurance premium is shared with the district government which contributes up to 72 percent toward the total premium cost. Duval county public schools is an equal opportunity school district.