{"id":392,"date":"2026-03-03T16:44:02","date_gmt":"2026-03-03T16:44:02","guid":{"rendered":"https:\/\/schooldistrictbenefits.com\/appoquinimink\/n\/?page_id=392"},"modified":"2026-04-27T19:39:04","modified_gmt":"2026-04-27T19:39:04","slug":"forms","status":"publish","type":"page","link":"https:\/\/schooldistrictbenefits.com\/appoquinimink\/n\/forms\/","title":{"rendered":"Forms"},"content":{"rendered":"

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Forms<\/h1>\n

Benefits related Forms and Links<\/h2>\n

[\/et_pb_text][et_pb_text _builder_version=”4.27.6″ _module_preset=”default” global_colors_info=”{}”]<\/p>\n

Benefits Enrollment forms are available in Frontline Central<\/a><\/span>. Please contact benefits@appo.k12.de.us<\/a> if you have any questions.<\/p>\n

[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row column_structure=”1_3,1_3,1_3″ _builder_version=”4.25.2″ _module_preset=”default” global_colors_info=”{}”][et_pb_column type=”1_3″ _builder_version=”4.25.2″ _module_preset=”default” global_colors_info=”{}”][et_pb_text admin_label=”medical forms” _builder_version=”4.27.6″ _module_preset=”default” global_colors_info=”{}”]<\/p>\n

Medical<\/h3>\n

Spousal Coordination of Benefits Form<\/a>
Dependent Coordination of Benefits – Aetna<\/a>
Dependent Coordination of Benefits – BCBS<\/a>
HIPPA<\/a><\/p>\n

[\/et_pb_text][et_pb_text admin_label=”vision” _builder_version=”4.27.6″ _module_preset=”default” global_colors_info=”{}”]<\/p>\n

Vision<\/h3>\n

VBA Benefit Summary<\/a>
VBA Member portal<\/a>
VBA Vision ID Card<\/a>
Progressive & Hearing VBA member flyer<\/a>
VBA Out-of-Network Reimbursement<\/a><\/p>\n

[\/et_pb_text][et_pb_text admin_label=”LTD” _builder_version=”4.27.6″ _module_preset=”default” global_colors_info=”{}”]<\/p>\n

Long-Term Disability<\/h3>\n

Cigna LTD Claim Process<\/a>
Cigna LTD Claim Form<\/a>
LTD Insurance Certificate<\/a>
Hartford LTD Claim Form<\/a><\/p>\n

[\/et_pb_text][et_pb_text admin_label=”group life” _builder_version=”4.27.6″ _module_preset=”default” global_colors_info=”{}”]<\/p>\n

State Group Accident and Illness Insurance<\/h3>\n

Add How to File a Claim<\/a><\/p>\n

[\/et_pb_text][\/et_pb_column][et_pb_column type=”1_3″ _builder_version=”4.25.2″ _module_preset=”default” global_colors_info=”{}”][et_pb_text admin_label=”dental forms” _builder_version=”4.27.6″ _module_preset=”default” global_colors_info=”{}”]<\/p>\n

Dental<\/h3>\n

Cigna Dental Benefit Summary Plan A<\/a>
Cigna Dental Benefit Summary Plan B<\/a>
myCigna.com<\/a>
Cigna Dental ID Card <\/a><\/p>\n

\u00a0<\/div>\n

[\/et_pb_text][et_pb_text admin_label=”Life AD&D” _builder_version=”4.27.6″ _module_preset=”default” hover_enabled=”0″ global_colors_info=”{}” sticky_enabled=”0″]<\/p>\n

Life & AD&D Insurance<\/h3>\n

Group Life Conversion<\/a>
Certificate of Insurance<\/a><\/p>\n

Effective July 1, 2026, MetLife will be our new Basic Life and AD&D Plan Administrator.\u00a0 More information will be added to the website soon.<\/i><\/p>\n

[\/et_pb_text][et_pb_text admin_label=”FSA” _builder_version=”4.27.6″ _module_preset=”default” global_colors_info=”{}”]<\/p>\n

ASI Flexible Spending Accounts<\/h3>\n

Flexible Spending Account Claim Form<\/a><\/p>\n

[\/et_pb_text][\/et_pb_column][et_pb_column type=”1_3″ _builder_version=”4.25.2″ _module_preset=”default” global_colors_info=”{}”][et_pb_text admin_label=”contact side” _builder_version=”4.27.6″ _module_preset=”default” custom_padding=”||20px|17px|false|false” border_width_left=”1px” border_color_left=”#0C71C3″ global_module=”375″ saved_tabs=”all” locked=”off” global_colors_info=”{}”]<\/p>\n

Questions?<\/h3>\n

<\/b>For questions or more information on anything not listed, please contact the Appoquinimink\u00a0Benefits Office:<\/strong><\/p>\n

Phone:<\/strong>
Ryann Tobey – 302-376-4129
Terez Trott – 302-376-4448<\/strong><\/p>\n

Email:<\/b>
benefits@appo.k12.de.us<\/a>
<\/b><\/p>\n

 <\/p>\n

 <\/p>\n

[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"

Forms Benefits related Forms and LinksBenefits Enrollment forms are available in Frontline Central. Please contact benefits@appo.k12.de.us if you have any questions.Medical Spousal Coordination of Benefits FormDependent Coordination of Benefits – AetnaDependent Coordination of Benefits – BCBSHIPPAVision VBA Benefit SummaryVBA Member portalVBA Vision ID CardProgressive & Hearing VBA member flyerVBA Out-of-Network ReimbursementLong-Term Disability Cigna LTD Claim […]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"class_list":["post-392","page","type-page","status-publish","hentry"],"jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/PhdndX-6k","_links":{"self":[{"href":"https:\/\/schooldistrictbenefits.com\/appoquinimink\/n\/wp-json\/wp\/v2\/pages\/392","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/schooldistrictbenefits.com\/appoquinimink\/n\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/schooldistrictbenefits.com\/appoquinimink\/n\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/schooldistrictbenefits.com\/appoquinimink\/n\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/schooldistrictbenefits.com\/appoquinimink\/n\/wp-json\/wp\/v2\/comments?post=392"}],"version-history":[{"count":5,"href":"https:\/\/schooldistrictbenefits.com\/appoquinimink\/n\/wp-json\/wp\/v2\/pages\/392\/revisions"}],"predecessor-version":[{"id":559,"href":"https:\/\/schooldistrictbenefits.com\/appoquinimink\/n\/wp-json\/wp\/v2\/pages\/392\/revisions\/559"}],"wp:attachment":[{"href":"https:\/\/schooldistrictbenefits.com\/appoquinimink\/n\/wp-json\/wp\/v2\/media?parent=392"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}