Medical Waiver Forms

If you are entitled to medical benefits as an Elizabeth School District Employee but you are eligible for medical benefits coverage under a spouse’s medical plan, you have the option to waive your coverage with the district and receive $2000 annually. You must submit proof of the other health coverage.

Your spouse/partner must not be enrolled in the State Health Benefits Program (SHBP) or (SEHBP) in order for you to qualify.


Download and fill out the Medical Application A and the New Jersey Coverage Waiver form and take them to the Human Resource department at the Mitchell building. Have them time stamped that you delivered them and make a copy for your records.

Medical Application A

New Jersey Coverage Waiver Form B