For anyone who marries, divorces, retains guardianship, etc., proof of such event will need to be attached to your signed enrollment form. If you do not include the appropriate proof of such event, this could delay adding, deleting, etc. such person or persons to or from your insurance.

Please complete and sign the enrollment forms and return to Gina VanGorden, Payroll & Benefits Specialist at the Administration Office. Please call me with any questions regarding the forms at (570) 638-2183 Ext. 308 or by email at


If you are having problems with claim rejections, payment, etc., please see the Claims Assistance Section.