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
Use this form if you are 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 the link 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. 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 Department.
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
Group #: 220069
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.
Located in the District Administration Building 1st Floor/Human Resources 45 E State Street Farmington, UT
Monday-Friday Phone: 801-402-5200
8:00-4:30 Fax: 801-402-5639
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