Additional Resources
Plan Features
Everything You’ll Need to Know
Plan Documents
Opt-Out Payment (In Lieu of Medical Coverage)
Coverage Information& Amounts
Opt-Out Payment Form(for Medical only)
(Proof of employer sponsored medical insurance required) The elections you make will remain in effect until the end of the plan year unless you experience a life change event.
IBC - Medical Claim Form
Email to HR at [email protected]
IBC- Handicapped Child Application
Application to Continue Coverage for Disabled Dependent Child
IBC - PPO Claim Form Out-of-Network
Email to HR at [email protected]
IBC - Davis Vision Care Reimbursement
Claim Form
Madison National Life Insurance Company, Inc. Change of Beneficiary Form
Upon completion of this form, keep a copy so that your beneficiaries may refer to it should a claim for Group Term Life benefits be necessary.
Websites
Contacts
Human Resources
Phone:
(610) 284-8005 ext. 1239
Madison National Life Insurance Company
Phone:
(800) 627-3660