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Insurance Forms & Information

ARBenefits for Arkansas State and Public School Employees and Retirees

2021 Insurance Rates

Open Enrollment for AR Benefits is during the month of October.

To cover a spouse, you will need to submit a copy of a marriage license and complete a Spousal Affadavit.

To cover dependents, you will need to submit a coy of your dependents Birth Certificates AND Social Security Cards.

Enrollment Form

Spousal Affidavit

 

2021 Wellness Discount Information

WELLNESS REQUIREMENTS

To earn any incentive put in place by the State and Public School Life and Health Insurance Board for the 2021 plan year, covered employees and any covered spouse must complete the following by October 31, 2020.

 

Biometric Screening:

Members can complete a biometric screening through a Catapult Health checkup or their own physician. Members who utilize their own physician need to have their physician complete the ARBenefits Primary Care Provider Form (PCP Form).

It is the member’s responsibility to make sure their completed PCP Form has been submitted by 10/31/20.

 

Health Assessment:

Members who complete a Catapult checkup also complete the health assessment requirement during their appointment.

Members who complete a checkup through their physician must also complete the online health assessment. The online health assessment needs to be completed through the member’s My Blueprint account at healthadvantage-hmo.com or through your ARBenefits Member Portal and clicking on Health Advantage.

After you log in to your My Blueprint account, go to the Health and Wellness tab and choose Healthy Living. Then Navigate to the HealthConnect Blue portal.

 

Tobacco Cessation:

Members who test positive for nicotine will once again be able to successfully complete the wellness program by participating in a tobacco cessation program.

There are two options available to complete the requirement. A telephonic program through New Directions, or an online program through Health Advantage’s My Blueprint portal.

 

Available Tobacco Cessation Programs

Online Program Through My Blueprint

Six-week course covering six modules. Member must complete all six weeks to complete the cessation requirement.  Access this program Health Adavantage’s My Blueprint portal.

Telephonic Program Through New Directions

Interested in utilizing the telephonic program? You can contact New Directions at 1-877-300-9103. Members are required to complete their first official coaching session to satisfy the requirement.

 

PCP Form

2020 Completing Health Requirements

 

 


 

1-844-559-3521

2020 Employee Benefit Guide (Employees must work at least 30 hours to qualify for benefits)

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Group Life

Beneficiary Change Form

 

Colonial Life

 

Colonial Life Information

Enrollment Form

Change of Beneficiary Form

Evidence of Insurability Form

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Data Path Enrollment Form

Data Path Claim Form

Instructions on How to Log Into Your HSA

 

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Delta Dental Information

Delta Dental Enrollment/Change Form

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VSP Information

 


 

WELLNESS FORMS

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For Hospital Care & Accident Policies 

By Mail: PO Box 1650, Little Rock, AR 72203-1650

FAX: 501-235-8400

USAble Wellness Claim Form

 

Allstate Insurance Company Logo

By Mail: 1776 American Heritage Life Drive, Jacksonville, FL 32224

FAX: 800-430-4188

Allstate Wellness Claim Form

 

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By Mail: PO Box 2609, Omaha, NE 68103-2609

FAX: 877-668-5331

Lincoln Wellness Claim Form