The Salary Reduction Agreement is no longer used.

Please use this guide to work with PlanConnect to add or change a voluntary annuity.

Questions can be directed to Rick Knapp in the Treasurer’s Office.

To apply for or cancel coverage with Anthem and Delta Dental, please visit the American Fidelity website.

For help logging in to American Fidelity Enrollment, download these instructions (PDF) | instructions (RTF).

To access a step-by-step guide to the online enrollment process, download this guide (PDF) | guide (RTF).

Anthem Lumenos HDHP-H.S.A. Summary of Benefits (SOB) (available for classified staff and administrators only)

Delta Dental Summary of Benefits

Anthem Blue View Vision – Plan A

Anthem Blue View Vision – Plan B

The Affordable Care Act requires every American to have health insurance—and just like you need paperwork to prove you have auto insurance, you now need to prove you have health insurance. Your 1095-C Form is your proof of insurance.

Similar to your W-2 Form, which gives the IRS details about how you were paid, the 1095-C Form is a way to give the IRS information about your health insurance and help the agency verify that your coverage meets the requirements under the Affordable Care Act (ACA).

Simply, it’s a way for you to show the government that you’ve met your obligation under ACA to have health insurance. Without the 1095-C Form and the information contained in it, you may not be able to fully file your yearly income taxes and may be subject to a fine by the IRS (2% of your yearly household income or $325 per person for the year, whichever is higher).

You’ll use the information on the 1095-C Form to certify on your 1040 tax form that you have health insurance.

What you need to do

When you get it—keep it. Easy as that! You’ll use the form to complete your tax return and verify your coverage to the IRS.

Second, verify that personal information, company information, and family members’ information are all correct.

If you see errors on your form, contact Rick Knapp in payroll.

More information

Download this 1095-C Guide for additional information.

FMLA Employee Rights Information (pdf)

FMLA Employee Rights Information (rtf)

Employees need to contact the Human Resources Department for FMLA forms and/or additional information.

FFCRA Employee Rights Information

Child Abuse Brochure (pdf)

Child Abuse Reporting Requirements Brochure (rtf)

First visit

The first visit to any medical provider, whether an emergency or non-emergency, is covered for a work-related injury considered compensable by the Bureau of Workers’ Compensation.

All other visits

After the first visit, if an employee obtains medical care for a work-related injury from a medical provider other than those noted below, workers’ compensation insurance may not cover the costs and the employee may have to pay for the services.

1. Emergency room
2. Urgent care facility
3. BWC certified physician

To get the name of a BWC Certified Physician, call 1.800.OHIOBWC on weekdays from 7:30 a.m. to 5 p.m. or visit the Bureau of Workers Compensation website provider lookup. If you are unsure who is a BWC certified physician, it is recommended you go to an emergency room or urgent care facility.

If your claim is denied by the Bureau of Workers’ Compensation, you have the right to appeal within 14 days of the claim denial date. You will be notified by the BWC with instructions on how to proceed

Step 1

Your health is the first priority! Don’t hesitate to seek professional care for a medical emergency.

A medical emergency is defined as: a) medical services required for the immediate diagnosis or treatment of a medical condition that if not immediately diagnosed or treated could lead to a serious physical or mental disability or death, or b) medical services that are immediately necessary to alleviate severe pain.

Step 2

Immediately submit an Employee Accident/Exposure Incident Report. Click here to submit an accident report online.

On that site, click on “Report an Employee Accident,” then click on “Submit Accident Report.” If you do not have a username or password, leave it blank and proceed in completing the report. Enter all information requested and follow the steps to submit your report.

Based on the information submitted, Public School Works may require the employee to take additional safety classes. An automatic email notification from personnel will be sent by the system if applicable. Please complete the necessary training and submit the completed paperwork to the payroll coordinator located at District Office.

For assistance, contact your immediate supervisor or the school nurse. For further assistance, call the Payroll Coordinator at 614.834.2148. The Employee Accident/Exposure Incident Report should be completed by the injured/affected employee; however, if necessary, another employee can complete the report with the assistance of the affected employee.