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Insurance Forms & Information

ARBenefits for Arkansas State and Public School Employees and Retirees

2019 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



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

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Group Life

Beneficiary Change Form


Data Path HSA Application

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

VSP Enrollment Form

Securian Financial

Minnesota Life Information & Enrollment Packet

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Wellness Claim Form

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