Health Benefits Waiver
The East Windsor Regional School District offers a health benefits package to its eligible employees. If an eligible employee is covered under an alternative plan, he/she may elect to waive the benefits offered by the district. In exchange for this waiver, please refer to your contract for waiver payout eligibility.
A form is required for ALL eligible staff members that are not currently enrolled in a district's health insurance plan.
Plan selection of WAIVE must be checked for each applicable plan - medical, prescription, dental, and/or vision.
Coverage selection of SINGLE, P+C, 2ADULTS, FAMILY must be made.
If waiving other than SINGLE, all applicable dependents must be listed under Dependent Information.
The form should be accompanied with a copy of the staff member's insurance card.
Email the completed form with a copy of the insurance cards to Email Lisa Tate before May 31.