Benefit Information and Forms
Health, Dental, Vision Plans 2023
- HSBT Benefit Guide 2023
- HSBT Enrollment Form
- American Fidelity HSA application (HSBT Plan 4 or 5 ONLY)
- Benefit Plan Notifications 2023
Pharmacy 2023
Questions about your Rx prescriptions? Call True Scripts at: 844-257-1955
Additional Benefit Information
Health/Dental/Vision Required Documentation for Dependents
HSBT - MyWellness Portal
Sun Life Disability and Life Insurance
- Certified Staff-Basic Life Enrollment Form
- Certified Staff Basic Life Certificate
- Support Staff Basic Life Staff Enrollment Form
- Support Staff Basic Life Staff Certificate
- Sun Life Beneficiary Change Form
- Voluntary Life Insurance
- Voluntary Life Insurance Enrollment Form
Cigna Long Term Disability
American Fidelity
- Benefits Overview
- Disability Claim Form
- Hospital Indemnity Claim Form
- Accident Insurance Claim Form
- Section 125 Flex Benefits Guide
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
- Please contact Amanda Pruitt for an Ineligibile for Coverage Marketplace Notice.
- FMLA Employee Guide
Paper copies of all required notifications are available upon request.
Contact
Amanda Pruitt
Benefits Specialist
317-856-5265 ext 18131