Benefit Information and Forms
Amanda Pruitt
Benefits Specialist
317-856-5265 ext 18131
Benefits Specialist
317-856-5265 ext 18131
The COVID-19 Public Health Emergency (PHE) enacted in February 2020 is set to expire on May 11, 2023. As a result, the following services will revert to standard benefits as of May 12, 2023.
- Cover recommended and CDC adopted COVID-19 vaccine and booster serum and administration in accordance with existing ACA preventive services benefit (zero-dollar cost share).
- No coverage of OTC(over the counter) COVID-19 tests.
Health, Dental, Vision Plans 2023
- HSBT Benefit Guide 2023
- HSBT Enrollment Form
- Required Documents for qualifying spouse or Dependent Enrollment
- American Fidelity HSA application (HSBT Plan 4 or 5 ONLY)
- Benefit Plan Notifications 2023
- Spousal Carve-Out Form
Pharmacy 2023
- NEW!!! TrueScripts Portal Updated
- I-Phone App Instructions
- Android App Instructions
Questions about your Rx prescriptions? Call True Scripts at: 844-257-1955
Employee Assistance Program/Health Coach
- EAP
- EAP Brochure (english)
- EAP Brochure (spanish)
- HEALTH COACH (english)
- Health Coaching FAQ (english)
- HEALTH COASH (spanish)
- Health Coaching FAQ (spanish)
OneAmerica Life Insurance
OneAmerica Voluntary Life Form
Cigna Disability
American Fidelity
- Benefits Overview
- Disability Claim Form
- Hospital Indemnity Claim Form
- Accident Insurance Claim Form
- Section 125 Flex Benefits Guide
- American Fidelity Name Change Form
Retirement Programs
- Teachers Retirement Fund (TRF)
- Public Employees Retirement Fund (PERF)
- Retired Teachers Health Insurance/VEBA Guidelines
- Optional 403(b) Plan
- TIAA
- Register for TRF Retirement Education Workshop
Required Notifications
- Health Plan Notification Booklet containing the Special Enrollment Rights, Medicare Part D Notice, WHCRA Notice and Notice of Grandfathered Status and the Health Insurance Portability and Accountability Act (HIPAA) Notice of Privacy Practices.
- Marketplace Notice
- FMLA Employee Guide
Paper copies of all required notifications are available upon request.