BSD Benefits Online

Forms

Download Benefits-related Forms

Medical

Spousal Coordination of Benefits Form
CVS Reimbursement Form
Dependent Coordination of Benefits – Aetna
Dependent Coordination of Benefits – Highmark BCBS

Vision

Benefit Summary
Informational Flier
Your Hearing Member Flier
VBA Member Portal Sheet
VBA Out-of-Network Reimbursement Form

Long-Term Disability

The Hartford LTD Claim Form
Cigna LTD Claim Process
Cigna LTD Claim Form
LTD Insurance Certificate for Admins
LTD Insurance Certificate for Non Admins

Dental

Cigna Dental Benefit Summary Plan A
Cigna Dental Benefit Summary Plan B
Cigna
myCigna.com

Life & AD&D Insurance

Notice of Conversion
Conversion Application
Portability Form
Life Claim Form
Certificate of Insurance

ASI Flexible Spending Accounts

Questions?

For questions or more information on anything not listed, please contact the Brandywine Benefits Office:

Phone:

302-793-5023 (Phone)
302-722- 5170 (Google Voice)

Email:

Dianne.howell@bsd.k12.de.us.