SCHOOL CLAIMS SERVICE, LLC

Serving the best interests of Pennsylvania's public schools

Forms

Dental & Vision

Printable Forms (to mail or fax)
Proposal Form
Administration Expense Report
COBRA Enrollment Notification
COBRA/Retiree Benefit Payment Reminder
Enrollment Change Form
Dental Claim Form
Vision Claim Form

Online Forms Administration -- Login page
- Administration Expense Report
- Fringe Benefits Enrollment Change Form
- COBRA Form

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Workers' Compensation

Printable Forms (to mail or fax)
Claim Form (Work-Related Incident Report Form)
Workers' Compensation Information Notice

Online Claim Submission
- Work-Related Incident Report Form

Employee Benefits

PDF Forms for
Pennsylvania School Entities
Disability Income Protection
Group Life Insurance
Section 125/TABS/Flexible Benefit Plans
Volunteer Risk Management Program

PDF Forms for
Ohio School Boards Association:
Group Life Participants

P.O. Box 811 | New Cumberland, PA 17070 | Phone: (866) 401-6600
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