Benefit Information and Forms

Hoosier School Benefit

 

Phone: 317-856-5265 ext 18131

Fax: 317-981-3167

 

Health, Dental, Vision Plans 2024

Click on the links below:

HSBT Benefit Guide 2025   Audio Presentation of the Benefit Guide

HSBT Enrollment Form 

Required Documents for qualifying spouse or Dependent Enrollment

American Fidelity HSA application (Required for HSBT Plan 4 or 5 ONLY)

Spousal Carve-Out Form

2025 RATE SHEET

Click on the links below:

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

PLATINUM (Certified Staff Only, Teachers/School Counselor/Psychologist) 
GOLD (Support staff who are year round 260 employees as well as less than 260 but salaried, such as SRO, CIS, OT/PT, 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)
*It is your responsability to be aware of the plans you are currently enrolled in.  With over 600 employees enrolled in different plans, please understand that it is not feasible for our benefits specialist to check each individuals plan.  It is recommended that you use Doculivery (link to instructions below) to look at your per-pay rate on your paycheck and then compare it to the appropriate rate sheet.*

Doculivery Instructions and Link to Electronic Pay Stub

Click on the links below:

Doculivery Instructions

Paystub Login

 

Pharmacy 2025

Click on the links below:

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 PRESENTATION

 

Click on the links below:

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

Click on the links below:

Group Life Beneficiary Form

OneAmerica Voluntary Life Form

Cigna Disability

Click on the links below:

American Fidelity

Click on the links below:

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

Click on the links below:

Teachers Retirement Fund (TRF)

Public Employees Retirement Fund (PERF)

Retired Teachers Health Insurance/VEBA Guidelines

Optional 403(b) Plan

Equitable Vision 401(a): 1-855-234-5152

US Bencor MidAmerica: 1-855-329-0095 or healthaccountservices@myMidAmerica.com

Register for TRF Retirement Education Workshop

Required Notifications

Click on the links below:

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.