Take care of your body it's the only place you have to live.
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Congratulations on the birth of your new baby!
Please click on this Status Change Form link.
Print and complete this form to add your new little one to your health insurance. Form must be returned
no later than 30 days from the date of birth.
You may return completed form to the District Insurance Office by:
Davis School District
Insurance Division/Nyoka Egan
P.O. Box 588
Farmington, UT 84025-0588
UNUM Evidence of Insurability Application (EOI)
(Use this link to complete your Open Enrollment request for disability insurance coverage)
Disability Claim Form
(Use this link to submit your claim through the US Mail or by Fax)
Disability Online Claim
Employee Self Service Instructions
(By following the step-by-step "Employee Self Service Instructions" you will be guided on how to submit your claim,
through a secure on-line portal, directly to UNUM through the "Disability Online Claim" link)
Use either the print-out version of the "Disability Claim Form" or,
follow the "Employee Self Service Online Claim Instructions" to submit your disability claim on-line.
(These forms are for employees who are currently enrolled with disability insurance, and wish to file a claim).
To file a claim for Short Term or Long Term disability benefits, please click on one of the links above and complete the application. It is the employee’s responsibility to complete pages 1 through 5 as well as the Authorization page. You will also need to have your physician complete pages 9 through 11. Once completed, please submit these forms directly to UNUM at the address provided on the application, by using the on-line portal application.
In order to complete the application process, please notify the insurance division at the link below so that we can complete and submit the employer sections (pages 6-8) of the application in a timely fashion.
Also, If you have not already done so, please apply for a leave of absence through
the Human Resource Associate Director, Steve Baker at: firstname.lastname@example.org
If you have any questions you can contact:
Rose Bassett at the link below or at 801-402-5636 Monday – Friday 8:00am – 12:00pmEmail
Rose Bassett: email@example.com
Open Access Aetna Select
Group # 0737435
Group # G1007099
Group # 3310
You will first need to call Opticare of Utah and request your member number.
Group #: 220069
Group # 537234
The Health Insurance Portability & Accountability Act of 1996 ("HIPAA") is a federal program that requires that all medical records and other individually identifiable health information used or disclosed by the District in any form are kept properly confidential.
To learn more about your rights or to obtain a copy of the District's Notice of Privacy Practices, please click HERE.
- Specific Plan Information
- Summary of Benefits and Coverage (Health Plans)
- Member ID Card Information
- Medicare Creditable Coverage Notice
- "Early Retirement Plan" Q&A
- Tele-Medicine Health Care Options
- Rx Comparison
- High Deductible Health Plan and Health Savings Account Education Tools
- Children's Health Insurance Program (CHIP) Notice
- The Hartford Supplemental Products Group # 32200696
- UNUM Supplemental Products Group # 537234
- Intermountain LiVe Well Employee Assistance Information
- Delta Dental Summary of Group Program
- Aetna Traditional Health Plan
- Aetna Qualified High Deductible Health Plan
- SelectHealth SelectMed Traditional Health Plan
- SelectHealth Health Save Qualified High Deductible Health Plan
- Basic Life Benefit Plan
- Supplemental Life Benefit Plan
- Opticare of Utah 120-B Plan
- UNUM STD Group Insurance Plan
- UNUM LTD Group Insurance Plan