Taylor County School DistrictEMPLOYEE VOLUNTARY BENEFIT INQUIRY

Taylor County School District

EMPLOYEE VOLUNTARY BENEFIT INQUIRY

Voluntary Benefit Changes

Accident, Critical Illness and Hospital Indemnity

Please complete and submit this form and someone from our Voluntary Benefits Service Team will contact you within two business days.

If you have questions regarding any benefits not listed above, please visit your employer's Benefits Resource Portal.

PLEASE NOTE

This form is not to be used for Medical, Dental, or Vision plans.

Full Employee Name*

Last Four Numbers Of SSN*

Preferred Phone Number*

Phone

Email Address*

Reason For Voluntary Benefit Inquiry*

Select

A Voluntary Benefits Service Team member will contact you within two business days after you submit this request.

Add / Remove Dep - Select Benefit*

*NOTE: This is limited to the voluntary benefits. For any benefits not listed here, please refer to your company's Benefits Resource Portal at the link above.

Accident

Critical Illness

Hospital Indemnity

Remove Benefit - Select Benefit*

Select the benefit(s) you are wishing to remove.

*NOTE: This is limited to the voluntary benefits. For any benefits not listed here, please refer to your company's Benefits Resource Portal at the link above.

Accident

Critical Illness

Hospital Indemnity

Notes / Comments

*NOTE: This is limited to the voluntary benefits. For any benefits not listed here, please refer to your company's Benefits Resource Portal at the link above.

Privacy Notice|Report Abuse