Arkansas Public School Retirees

Plan Information

New Benefits Effective Jan. 1, 2011

Services Provided through Arkansas Employee Benefits Division

The Employee Benefits Division (EBD) of the Department of Finance and Administration is the administrator for the ARHealth Plan. You will find all of the benefit/limitation information, forms and contact information for your plan at www.arbenefits.org. EBD maintains all member eligibility, including dependent status and required documentation. EBD is also the COBRA administrator for the ARHealth plan.

If you are a Public School retiree, eligibility questions should be directed to EBD. If you are a COBRA retiree, or are considering COBRA, those questions will also need to be directed to EBD.

Health Advantage

The Employee Benefits Division (EBD) and Health Advantage, a subsidiary company of Arkansas Blue Cross and Blue Shield, partnered in 2005 to offer the ARHealth plan to retirees with Medicare. All Medicare and non-Medicare Arkansas State and Public School Retirees are enrolled automatically in the ARHealth Plan upon retirement.

Health Advantage has offered health insurance products to public school employees and their dependents for more than 10 years. We understand the importance of having local access to customer service for you and your family. If you need to walk in and speak with someone, we are there to help you, with our offices in Texarkana, Little Rock, Hot Springs, Jonesboro, Fort Smith, Pine Bluff and Fayetteville. These local offices provide services to all the counties within their region.

If Medicare is not your primary coverage, the ARHealth plan features as follows:

• Automatic enrollment upon retirement.
• No need to select a primary care physician (PCP).
• Many preventive services covered at 100 percent.
• Your copayment will be $25 for PCP visits and $35 for specialist visits.
• In-network coinsurance will be 20 percent on many services.
• You can use any doctor or hospital in the state in the Health Advantage network without a referral.
• If you elect to use an out-of-network provider within Arkansas, your out-of-network coinsurance will be 40 percent and the out-of-network deductible amount will be $1000 per individual and $2,000 per family, with a maximum out-of-pocket expense of $5,000 per individual and $10,000 per family.
• If you wish to obtain services from an out-of-state provider, visit the BlueCard® PPO network.
• Your prescription drug benefits and mental health benefits will remain the same.
• One vision screening will be covered every 24 months with a $35 copayment.
• One hearing screening will be covered every 36 months with a $35 copayment.
• Hearing aids will be covered — $1400 per ear per every three years. You may use any supplier you choose.

If Medicare is your primary coverage, the ARHealth plan features remain as follows:

• If Medicare is your primary coverage, you will be enrolled in this plan upon retirement.
• If you become Medicare eligible during the year, your coverage will be supplemental to traditional Medicare A and B benefits. Send the Employee Benefits Division a copy of your Medicare card as soon as you receive it.
• Your ARHealth plan coordinates with any qualified Medicare plan (Medicare A, Medicare B and Medicare C — also called Medicare Advantage or Medicare replacement plans).
• No need to select a primary care physician (PCP).
• You can see any physician — anywhere in the United States.
• If you are a public school retiree, the premium for the ARHealth plan has been substantially reduced to enable you to purchase a Medicare Part D Prescription Drug Plan of your choice.
• Mental health benefits are covered by Medicare and ARHealth.
• Your ARHealth plan will cover one vision screening every 24 months, with a $35 copayment, even if not covered by Medicare.
• Your ARHealth plan will cover one hearing screening every 36 months, with a $35 copayment, even if not covered by Medicare.
• Your ARHealth plan will provide coverage for hearing aids — $1400 per ear every three years. You may use any supplier you choose.

Pre-certification: Some services may require advance approval (pre-certification). Please read this important information about pre-certification, appeals and case management.

BlueCard^®

As an ARHealth member through Health Advantage, you have more freedom to choose the doctors and hospitals that best suit you and your family. Your coverage gives you a world of choices through the BlueCard^® Program.