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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

 

2021 Wellness Discount Information

The WSD Catapult Health Clinic has been set for June 8,9 & 10th, 2020.  It will be held at SEACBEC.

It is not too early to reserve your spot.  Click on the link below to schedule an appointment.  This Checkup is @ no cost to you.

To schedule your appointment please visit  www.TimeConfirm.com/ARBenefits.

This checkup should take about 40 minutes and will include finger stick blood test (to measure glucose level, lipids, liver enzymes & A1C), BMI - biometric measurements (height, weight, etc), depression screening, nicotine screening and a private consultation with a nurse practitioner. 

During this visit the employees & spouses will also complete the Health Assessment.

More information to come soon.

 

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

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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

 

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