Lancaster County
Personnel Department
Risk Management Division
Personnel Department
Risk Management Division
AFSCME & Non-represented
FOP Lodge 29 & Deputy Sheriff's
FOP Lodge 32 & Corrections Officers
Coordination of Benefits
Schedule of Benefits Summary
Enrollment/Change form
Summary Plan Description
Benefits Overview
Authorization For Release of Protected Health Information form
Drug Formulary (April 2012)
Stay In-Network Brochure
Stay In-Network Poster
Member Presentation Powerpoint
H1N1 Vaccine
LB551 Extension of coverage form
Extension of coverage for dependents to age 26 
Childrens Health Insurance Program 
Notice of Privacy Practices
Customer Service number: 1-800-642-8980 orwww.bcbsne.com
Plan Highlights
Group Enrollment/Change or Waiver Form
Customer Service number: 1-800-487-5553 or www.ameritasgroup.com
Vision Plan
Enrollment/Change or Waiver Form
Customer Service number: 1-866-289-0614 or www.eyemedvisioncare.com
On-Line Enrollment Form
Quick Reference Guide
Flexible Spending Account Flyer
Payflex Card Flyer (Current Participants)
Payflex Card Flyer (New Participants)
Summary of Plan Description
Summary of Material Modifications
Health Care Reform Act 
Over the Counter Drugs and Medicines Information
Over the Counter Legislative Update 
Claim Form
Customer Service number: 1-800-284-4885 or www.mypayflex.com
Hartford Annual Enrollment Letter
Lancaster County Benefit Plan
Supplemental Life Brochure
Hartford Personal Health Application
Supplemental Life Financial Protection
Supplemental Life Needs
Supplemental Life Simplified Medical Underwriting Application
Supplemental Life Insurance and Accidental Death & Dismemberment Enrollment Form
Group Life and/or Accidental Death & Dismemberment Claim Forms for Employee or Dependent
Group Life Portability Outline
Supplemental Life Insurance and Accidental Death & Dismemberment Enrollment Form for New Hires
Employee Travel Assistance Program
Beneficiary Assist Program
Estate Guidance Will Services
Funeral Planning and Concierge Services
Life and Accidental Death and Dismemberment Insurance
Prudential Brochure
Contact number: 402-484-3826 or Email: Vera Schneider
Personnel Homepage
Risk Management