Lancaster City Schools (SCOIC)

RETIREMENT
SERS STRS

Employee Payroll Forms
Please print, complete and send directly to LCS Payroll Dept. Jodi Miller email: [email protected] Beckie Blake email: [email protected] Direct Deposit Form ESS Setup Instructions Ohio State Withholding IT4 Payroll Schedule 2025-2026 SSA-1945 Form STRS SERS MembershipForm W-4 2025

FMLA
Please print, complete and send directly to LCS Human Resources Dept. Anne Brengman email: [email protected] Teri Craiglow email: [email protected] Michelle Williams email: [email protected] FMLA FAMILY ILLNESS FMLA PERSONAL ILLNESS FMLA-Notice of Eligibility Rights Responsibilities

American Fidelity
AF PREGNANCY QUICKCLAIMS AMERICAN FIDELITY ACCIDENT ONLY CLAIM AMERICAN FIDELITY CANCER CLAIM AMERICAN FIDELITY CRITICAL ILLNESS CLAIM AMERICAN FIDELITY DISABILITY CLAIM AMERICAN FIDELITY HOSPITAL INDEMNITY CLAIM AMERICAN FIDELITY ROUTINE PREGNANCY CLAIM American Fidelity website link

Workers Compensation
Please direct any questions directly to Beckie Blake email: [email protected] BWC Designation Agreement BWC Instructions BWC Salary Continuation Agreement BWC Steps First Report of Injury Form Injury Flow Chart - WC Sedgwick Flyer

Required Notices for Open Enrollment and New Hires
2024 Notice of Privacy Practices (distributed every 3 years) Exchange Notice Rights and Protections Against No Surprise Medical Bills Women's Health & Cancer Rights Act

Summary Plan Description (SPD)
CAREFACTOR DENTAL PLAN LCSD "GRANDFATHERED" PLAN OPTIONAL PPO & BRONZE MVP PLANS

Insurance Benefit Rates
2026-2027 Rates

Employee Communications

CareFactor Member Portal Instructions

Mobile App Instructions

Vision Summary (VSP) (Voluntary)
VSP Doctor Directory VSP Voluntary Benefits Summary

BENEFIT ENROLLMENT FORMS
BASIC LIFE INSURANCE ENROLLMENT FORM LCSD MED/DENT ENROLLMENT FORM Ohio Deferred Compensation VSP ENROLLMENT FORM

AUL/One America Life Insurance
http://www.int-hr.com $50k /$75k Administration Exempt Basic Life Policy Beneficiary Form for AUL (Board Paid / Vol. Ins.) Certified & Classified Basic Life Policy VTL SUPPL RATES 1.1.25

Employee Forms
Accident Claim Form Authorization for Release of Information Form Instructions on how to submit an employee form Other Insurance Information

Prime Therapeutics
Prime App Prime Mail Order Form Prime Prior Auth Prime Rx Reimbursement

Wellness
1800MD Program Diabetic Program (E3 Program) EAP AUL ONE AMERICAN Employee Assistance Program (TELUS) Employee Assistance Program (TELUS)(App Flyer)

Contact Information

Eligibility, Benefits, Claim Status Inquiries, or additional ID cards:

contact CareFactor at 877-304-0761 http://www.mycarefactor.com/
OR Miller-Lewis Benefit Consultants (Now known as Acrisure)
(name change only) at 740-654-4055 Email: [email protected]

Prime Therapeutics Prescription 1-800-424-5821 or email
https://www.primetherapeutics.com/

Prime Therapeutics Prescription Drug List (Formulary)

https://prime.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtOTQw

ACMS for specialty pharmacy (assistance with high cost medications):
614-335-9004 OR Email: [email protected]

Ohio PPO Connect (PPO): 888-258-7621 OR  http://www.ohioppoconnect.com/

National Access Program (outside of the Ohio PPO Connect coverage area):
800-687-0500 OR https://providerlookup.healthsmart.com/ Use Group #: SCOIC

American Fidelity

Ryan Dieter - District Representative
877-518-2337 Office/844-565-2235 Fax
[email protected]

Central Office

Holly Roofe/ Office Manager/ Benefits
740-687-7359   [email protected]
Kendra Smith / Office Manager- Human Resources/ Treasurer's Office
740-687-7315 [email protected]

Featured Resources
Live Well, Work Well Newsletter - June 2026

Live Well, Work Well Newsletter - June 2026