Junior High

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Graphic of family


Take care of your body it's the only place you have to live.

-Jim Rohn

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Add Baby

 New Baby

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:

 Fax: 801-402-5639
Email: insurance@dsdmail.net
U.S. Postal:
Davis School District

Insurance Division/Nyoka Egan
P.O. Box 588
Farmington, UT 84025-0588

Disability Info.

Disability Information

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: stbaker@dsdmail.net

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: rbassett@dsdmail.net

Insurance Forms

Company Contact & Group Number Information

Aetna Logo

Customer Service:

Open Access Aetna Select
Group # 0737435

SelectHealth Logo

Customer Service:

Group # G1007099

Delta Dental Logo

Customer Service:

Group # 3310

Opticare of Utah Logo

Customer Service:

VBA= Member ID Number.
You will first need to call Opticare of Utah and request your member number.

Customer Service:
Group #: 220069

Customer Service:

Group # 537234

Customer Service:

Customer Service:
Local: 801-442-3509
Email: eap@imail.org

URS Logo

Customer Service:
Local: 801-366-7770

National Benefits Services NBS Logo

Customer Service:
Local: 801-532-4000
Fax: 1-800-478-1528

Notice of Privacy Practices

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.

Contact Us

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

Steven Baker

Steven Baker
HR Associate Director
Insurance Division


Rose Bassett
Insurance Specialist


Amy Cagle
Amy Cagle
 Insurance Technician

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

Medicaid and the Children's Health Insurance Program (CHIP) offer free or low-cost health coverage to children and families. Click HERE for more information on this program.

The Hartford Supplemental Products Group # 32200696

UNUM Supplemental Products Group # 537234

Intermountain LiVe Well Employee Assistance Information