Skip to main content

Insurance Forms & Information

Log in to ARBenefits

PO Box 15610

Little Rock, AR  72231-5610


2022 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


2023 Wellness Discount Information




The ARBenefitsWell program is a program that allows for a monthly discount in premiums for active Arkansas state employees and public school employees when certain wellness criteria are met during the 2022 plan year. Any discount put in place would be effective January 1, 2023. Retirees are not eligible for the ARBenefitsWell program.  


Program Requirements

To receive the discount in 2023, employees and covered spouses BOTH must complete a wellness screening through your physician. There are no forms that need to be completed and submitted in order to receive the discount.

Active employees and covered spouses have until October 31, 2022 to complete all requirements.

New Hires:  New state or public school employees hired on or after July 1, 2022, or an employee who transfers to another agency or school district with a break in coverage, will automatically receive the wellness premium discount for the 2023 plan year.

Failure to Meet the Deadline: If an active employee and/or covered spouse fails to complete the wellness visit by October 31, 2022, that employee will be ineligible to receive a monthly discount for any part of the 2022 plan year.



Employees must work at least 30 hours to qualify for benefits.

2022 Employee Benefit Guide

Image result for usable

PO Box 1650

Little Rock, AR  72203


Group Life

Beneficiary Change Form


Colonial Life


Colonial Life Information

Enrollment Form

Change of Beneficiary Form

Evidence of Insurability Form

Image result for datapath hsa


Data Path Enrollment Form

Data Path Claim Form

Instructions on How to Log Into Your HSA

Replacement Card Request


Image result for delta dental

PO Box 1789

Lowell, AR  72745


Delta Dental Information

Delta Dental Enrollment/Change Form

Image result for vsp

PO Box 45262

San Francisco, CA  94145-0262


VSP Information



Image result for usable 

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


Image result for Lincoln financial group

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

FAX: 877-668-5331

Lincoln Wellness Claim Form


Transamerica employee benefits offerings with stop loss quotes - National  Underwriting Services

Questions about TransAmerica Cancer Wellness Claims

Call the Claims Customer Service Department

at 800-251-7254 and press 2.

Transamerica Cancer Wellness Claim Information