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 HR – Verghese, Anitha 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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