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Insurance Forms & Information

ARBenefits for Arkansas State and Public School Employees and Retirees

2020 Insurance Rates

2020 Benefit Snapshot Sheet

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

 

2020 Wellness Discount Information

Employees & Spouses have the opportunity to qualify for the 2020 Wellness Discount by completing a Biometric Screening & Health Assessment.  

Below are the steps needed to receive the discount:  

In order to qualify, covered employees and any covered spouse must complete all requirements no later than October 31, 2019.

Employees & Spouses can still use their own PCP. The must have their doctor complete a Primary Care Provider Form. Below is the form for the doctor to fill out and it is the employee's responsibility to fax this form to AR Benefits @1-833-323-4329 & complete the on-line Health Assessment.

To complete the on-line Health Assessment, you have to create an account with https://myblueprint.healthadvantage-hmo.com/

 

Please Note:

If the employees and/or spouses test positive for nicotine, they must enroll in a tobacco cessation program.   A telephonic program is still available to members.

The Telephonic program (a one hour phone call) will be open until 10/31.  Please call 1-877-300-9103 to complete the program.

 

PCP Form

Wellness Fact Sheet

Instructions for Completing the Online Health Assessment

Instructions for Completing the Tobacco Cessation Requirement

 

 

1-844-559-3521

2019 Employee Benefit Guide (Employees must work at least 30 hours to qualify for benefits)

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Group Life

Beneficiary Change Form

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Data Path Enrollment Form

HSA Fact Sheet

HSA Eligible Expenses

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

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Wellness 

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