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Information and Forms

Benefit Information

Anthem HDHP Summary of Benefits & Coverage

Anthem PPO Summary of Benefits & Coverage

Guardian Vision Benefits

Guardian Vision Provider Directory

HRI Dental Benefits

HRI Dental Network Info

Life Insurance Certificate (Active Employees)

Life Insurance Certificate (Retired Employees)

Life Insurance Certificate (Additional Voluntary Amount)

Long Term Disability Certificate (Certified Employees)

Long Term Disability Certificate (Non-Certified Employees)

403(b) Information

Forms

Anthem Enrollment Form

Anthem Change Form

Anthem Claim Form

Guardian Vision Enrollment Form

Guardian Vision Claim Form

HRI Dental Enrollment Form

AUL Life and Long Term Disability Enrollment Package

AUL Life Insurance Beneficiary Designation Form

AUL Long Term Disability Claim Form

American Fidelity Medical Reimbursement Form

Express Scripts Form

Direct Deposit Agreement

W-4

WH-4

 

North Daviess Community Schools5494 East State Rd 58Elnora, IN  47529

812-636-8000

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