Health Enrollment Forms - ESPOP
Enrollment Form
Waiver of Coverage - Health and Dental
If you elect not to enroll in district-provided insurance plans, please complete the Waiver and Coverage form and return it to the benefits office.
Spouse Medical Coverage
If you wish to enroll your spouse in the District's insurance plan, please complete the Certification for Spouse Medical Insurance Coverage form and return it to the benefits office.
HIPAA (Health Insurance Portability & Accountability Act)
If you have elected enrollment in the Altoona Area School District’s health insurance plan(s), you must list your spouse and dependents (as applicable), please complete the HIPPA-Covered Spouse form and return it to the benefits office.