• Human Resources
  • Employee Insurance

Employee Insurance

Please review the following insurance forms.  Click a title to review and print.

Employee Insurance

#Name
1Change Form (Rev. 10/2010)Change Form (Rev. 10/2010)
2Deposit Affidavit Deposit Affidavit
3Enrollment FormEnrollment Form
4Express Scripts MailorderExpress Scripts Mailorder
5Eligibility BulletinEligibility Bulletin
6Express Clinic BrochureExpress Clinic Brochure
7Insurance PremiumsInsurance Premiums
8Provider Directory InstructionsProvider Directory Instructions
9South Central - Dental Blue w/o SignatureSouth Central - Dental Blue w/o Signature
10South Central - SOB#1 w/o SignatureSouth Central - SOB#1 w/o Signature
11South Central - SOB#2 - w/o SignatureSouth Central - SOB#2 - w/o Signature
12South Central - SOB#3 w/o SignatureSouth Central - SOB#3 w/o Signature


Anthem Contact Information
Member Services
1-800-295-4119

ace 1310604369 1272288630Precertification
1-877-814-4803

Provider Services
1-800-345-4344

Dental Services
1-866-589-0578

Rx Provider Services
1-800-662-0210

WHO CAN HELP YOU FOR CLAIMS INCURRED BEFORE 11/01/09?
For questions on benefits or claims:
Claim's Administrator: WEBTPA
1-800-953-2023

South Central Indiana School Trust
Julie Burton - Administrator
500 Earlywood Drive
Franklin, IN 46131
Phone 1-317-738-5972
Fax 1-317-738-5972