BTSD Employee Forms Library
Plan Features
Everything You’ll Need to Know
After completing your benefit elections, download the applicable forms and send them to Jenien Desilvis, the HR Benefits Specialist, at [email protected]
If needed, when filling out your Evidence of Insurability (EOI), use the following information:
- EOI Application: LTD (Madison National Life) ~ Group #: 013400, Bensalem Township School District Policy: Madison National Life Insurance Company, Inc., 7818
- EOI Online Instructions: Voluntary Life (CM Regent) ~ Group: Bensalem Township School District Policy: Sun Life Assurance Company of Canada- Policy Number: 932571 (Division location and Billing code are not needed.)
Plan Documents
Change of Address and Local Tax Forms
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Disabled Child Member form
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Disabled Child Physician form
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EOI Application: Voluntary Life (CM Regent)
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EOI Online Instructions: Voluntary Life (CM Regent)
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EOI Application: LTD (Madison National Life)
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