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The School District of Osceola County, Florida

Every Child, Every Chance, Every Day!

Forms

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Center for Employee Health

AdventHealth transfer of medical records to RosenCare Request Form

SDOC-Sep4-Consent-to-Release-Medical-Records-for-Treatment.pdf 80.66 KB (Last Modified on May 11, 2020)

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EyeMed- Effective 10/1/2017

EyeMed Out of Network Claim Form

EM OON Claim Form.pdf 182.93 KB (Last Modified on May 11, 2020)

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Humana Dental Effective 10/01/2019

Humana Benefits Booklet

Humana Dental.pdf 14.8 MB (Last Modified on May 11, 2020)

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Lincoln Financial Group Disability Forms -Effective 10/1/2017

Disability Claim Form

Lincoln Disability Claim Form.pdf 480.76 KB (Last Modified on May 11, 2020)

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OSCEOLACTY- STD One Call Claims Brochure.pdf

OSCEOLACTY- STD One Call Claims Brochure.pdf 475.69 KB (Last Modified on May 11, 2020)

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MetLife Life Insurance

Term Life Insurance Beneficiary Change Form

Term Life Beneficiary Form.pdf 11.47 KB (Last Modified on May 11, 2020)

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Tax Sheltered Annuities Forms

457(b) Unforeseen Financial Emergency Disclosure

457b_Unforeseen_Financial_Emergency_Disclosure.pdf 18.17 KB (Last Modified on May 11, 2020)

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Hardship Withdrawal Disclosure

Hardship_Withdrawal_Disclosure.pdf 15.97 KB (Last Modified on May 11, 2020)

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Osceola Disclosure Form

Osceola_Disclosure_Form.pdf 73.24 KB (Last Modified on May 11, 2020)

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Trustmark Forms - New 2017 Rates Effective 10/1/2017

Trustmark Accident Claim Form

Trustmark Accident Ins 17-18.pdf 134 KB (Last Modified on May 11, 2020)

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Trustmark Accident Ins 17-18.pdf

TRUSTMARK ACCIDENT CLAIM FORM.pdf 495.41 KB (Last Modified on May 11, 2020)

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Trustmark Universal Life/Death Claim Form

TRUSTMARK UNIVERSAL LIFE DEATH CLAIM FORM.pdf 338.34 KB (Last Modified on May 11, 2020)

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Aetna Disability Forms (claims beginning 10/01/2013)

Medical Treatment Claim Form

AetnaMedicalTreatmentBenefitClaimFormFL9-2013.pdf 53.69 KB (Last Modified on May 11, 2020)

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To file a disability claim, follow the instructions here.

EducatorTelephonicClaimFilingviaPhone.pdf 218.96 KB (Last Modified on May 11, 2020)

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Delta Dental Insurance Forms (10/1/2016-09/30/2019)

Ortho Takeover Form

DELTACARE CONTINUOUS ORTHO CARE FORM.pdf 89.03 KB (Last Modified on May 11, 2020)

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PPO Claim Form

DELTA DENTAL PPO CLAIM FORM.pdf 367.34 KB (Last Modified on May 11, 2020)

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