Benefit Information and Forms

Amanda Pruitt

Benefits Specialist

(P): 317-856-5265 ext 18131

(F): 317-981-3167

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 2024

HSBT Benefit Guide 2024   Audio Presentation of the Benefit Guide

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

2024 RATE SHEET

*Administration will need to reach out to the benefits specialist for their rate sheet*

PLATINUM (Certified Staff Only, Teachers/School Counselor) 
GOLD (Support staff who are year round 260 employees as well as less than 260 but salaried, such as SRO, CIS, OT/PT, Psychologist, Speach Therapist, ETC)
BLUE 24 (Support staff who are less than 260 and hourly but opted for 24 pay) 
BLUE 21 (Support staff who are less than 260 and are on 21 pay)

Pharmacy 2024

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)

HSBT members interested in health coaching click this link to schedule an appointment with one of the Health Coaches

 

Schedule an Appointment

 

OneAmerica Life Insurance

Group Life Beneficiary Form

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

Manager:  Michael Marshall - michael.marshall@americanfidelity.com - 317-556-1194

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.