New Hires Only
Plan Features
Everything You’ll Need to Know
Plan Documents
Benefit Enrollment Form
Please Complete
ESPA Benefit Enrollment Form
ESPA Please Complete
Employer Paid Life & Voluntary Life & Disability Insurance
Please Complete
Life Insurance Beneficiary Form
Please Complete
HSA Payroll Deduction Authorization Form
Please Complete if Contributing to HSA Plan
Insurance Waiver Form
Please Complete if Waiving Coverage
Insurance Waiver Form for Teachers, Administration, SPO, Security & Teamsters
Teachers, Administration, SPO, Security & Teamsters Please Complete if Waiving Coverage
Insurance Waiver Form for ESPA
ESPA Please Complete if Waiving Coverage
Websites
Contacts
Cynthia Ayers
(570) 459-3111 x3122
HASD Asst. Personnel / Benefits Supervisor
Renee Slakoper
(570) 669-7633
ETA Insurance Group, Account Manager
Michelle Searfoss
(570) 669-7634
ETA Insurance Group, Client Service Specialist